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.