Acetaminophen overdose in children

Acetaminophen metabolism. N-acetyl-p-aminophenol (APAP) is the active component of acetaminophen and is metabolized by 3 pathways: glucuronidation, sulfation and glutathione conjugation. Glucuronidation and sulfation produce nontoxic metabolites for excretion. N-acetyl-p-benzoquinoneimine (NAPQI) is a toxic intermediate produced by cytochrome P450 2E1 (CYP2E1; the main metabolizing agent) and cytochrome P450 3A4 (CYP3A4) metabolism. NAPQI is then conjugated by glutathione to form a nontoxic metabolite for excretion.