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Endogenous reactive oxygen species are produced by NAPQI linked to the thiol group of GSH, resulting in lipid peroxidation and cell death 60

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However, malnutrition and starvation are difficult to assess clinically and in particular protein-calorie malnutrition can co-exist with chronic alcohol use and with inter-current acute or chronic illness, which may independently or in concert increase the risk of paracetamol toxicity and confound the assertion that malnutrition per se increases the risk of paracetamol toxicity [6, 16, 73, 78,79,80,81,82,83]

Its antioxidant effects also help protect skin cells from environmental stressors, which support skin elasticity and reduce appearance of fine lines over time

While the health need is great, the near-term financial pressure feels unsustainable