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Factors influencing APAP-related hepatotoxicity The most essential determining factor in both the development and severity of APAP hepatotoxicity is the drugs ingested dose, but some argue that the length of time from APAP ingestion to N -acetylcysteine (NAC) therapy (time to NAC) is equally if not more important

Oxidative stress also contributes to necrosis by damaging cell membranes through lipid peroxidation and exacerbating calcium dysregulation, leading to cell swelling and lysis (Munoz et al., 2017