Acetaminophen toxicity Most patients who overdose on acetaminophen will initially be asymptomatic, as clinical symptoms of end organ toxicity do not manifest until 24 48 hours after an acute ingestion. Therefore, to identify a Paracetamol toxicity Deranged Physiology A 48 hour fast can turn standard Paracetamol into acute liver failure. Fasting depletes Glutathione, leaving the liver defenseless against toxic NAPQI. Review the latest guidelines on BMJ Best Practice: https: bestpractice.bmj.com topics en us 1010 Our Science Nacuity Pharmaceuticals