Well, to answer your questions: paracetamol's exact mechanism of pain relief is debated, as scientists argue if its main effect in the body is purely from blocking COX enzymes or involves other pathways in the brain and spinal cord. In an overdose, it depletes a protective substance in the liver called glutathione, and when that's gone, a toxic metabolite runs rampant and kills the cells.
From where I stand, in the ICU, I see the danger isn't just in massive overdoses—it's in the quiet, repeated small overdoses by people who don't read labels, thinking "it's just a paracetamol." My most heartbreaking cases are often from that, not the single dramatic suicide attempt.
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