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Depending on dose, a fraction of APAP is converted into a highly reactive toxic intermediate, N-acetyl-p-benzoquinone imine (NAPQI) by several P450 cytochromes[4]
The deficiency can disrupt how the heart muscle "recharges" between beats

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[DOI] [PubMed] [Google Scholar] 190.Townsend DM, Findlay VJ, Fazilev F, et al