Note. The image was created in original work from author’s T.M. and L.Q. adapted from research and information sourced from Mazaleuskaya LL, Sangkuhl K, Thorn CF, FitzGerald GA, Altman RB, Klein TE. PharmGKB summary: pathways of acetaminophen metabolism at the therapeutic versus toxic doses. Pharmacogenet Genomics. 2015;25(8):416-426. doi:10.1097/FPC.0000000000000150. This image is a direct illustration from the author’s personal collection: Miller, T.J., Qiu, L. (2025). Metabolic Processing Flowchart of Acetaminophen. Author’s personal collection.
Author Contribution Statement:
Theodore Miller : Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing - original draft, Writing - review & editing. Linda Qiu : Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing - original draft, Writing - review & editing. Andrew Nevin : Validation, Visualization, Writing - review & editing. Ronald Williams : Supervision, Validation, Writing - review & editing. Wilbert Beachy : Supervision, Visualization, Writing - review & editing.
Patient Consent Statement:
“The patients/patients’ legal guardian in this manuscript have given written informed consent to the publication of their case details”.
Key Clinical Message:
Prescribing appropriate dosing regimens for patients extends outside of weight-based considerations and requires proper evaluation of an individual’s metabolic complexities. Those with reduced metabolic capacity and diminished pharmacokinetics, including elderly and frail populations, should be considered for pediatric dosing reducing poor health outcomes and overdose events.