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This localized hypoxia (lack of oxygen) forces cells to switch to anaerobic energy production, generating excessive lactic acid and causing rapid, severe muscle fatigue even after minimal physical exertion

doi:10.1074/jbc.M209372200

Liver metabolism during glucouronidation or sulfation, CYP activity and maintenance of hepatic GSH supply depends on patient factors such as age, nutritional status, pre-existing liver disease, concurrent use of alcohol and other liver-metabolized medications, genetic predispositions, and most importantly, the acuity or chronicity of APAP overuse.3,15,17,2030 Table 1

The same pharmacology applies when vitamins or minerals are administered