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The figure below shows the mechanism of NAPQI generation and its further metabolism, as well as the possible mechanism of NAC in removing NAPQI

Nakade Y, Iwata Y, Furuichi K, Mita M, Hamase K, Konno R

Protein structural characterization methods all have limitations

We can perform an initial examination and provide guidance on the next steps to take

Evidence indicated that the dysregulation in mitochondrial function would have negative effects on the both hemostasis of cellular ions and the stability of the cellular membrane, leading to cortex excitability(29, 30)

In these patients who would like to initiate treatment, a thorough history should be obtained to determine the opioid used, if possible, and observation may be offered until potential re-intoxication and withdrawal syndrome is seen