A 48 hour fast can turn standard Paracetamol into acute liver failure. Fasting depletes Glutathione, leaving the liver defenseless against toxic NAPQI. Review the latest guidelines on BMJ Best Practice: https: bestpractice.bmj.com topics en us 1010 Combination of Paracetamol and the Glutathione Depleting Agent Buthionine Sulfoximine Show Differential Effect on Liver Cancer Cells and Normal Hepatocytes Paracetamol Induced Hepatotoxicity , Overdose NAPQI formation Glutathione depletion Liver cell necrosis. Early N acetylcysteine (NAC) can save the liver., #Pharmacology #mbbs #Hepatotoxicity File:Paracetamol metabolism.svg Wikimedia Commons Acquired pyroglutamic acidosis due to long term dicloxacillin and paracetamol use BMJ Case Reports Silymarin prevents acetaminophen induced hepatotoxicity via up regulation of the glutathione conjugation capacity in mice ScienceDirect