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Furthermore, if APAP metabolism occurs in the face of limited GSH levels, such as in the case of alcohol consumption, free unconjugated NAPQI reacts with sulfhydryl groups on cysteine and lysine residues, generating NAPQI-protein adducts (APAP-protein adducts) in hepatocytes, particularly in mitochondria, leading to mitochondrial dysfunction and cell death (Yuan and Kaplowitz, 2013)