The Gamma-Glutamyl Cycle and Drug Metabolism

The gamma-glutamyl cycle is known and beloved to all of us, just sort of by heart. The idea is to make the drug polar so that it can be excreted by the kidney. If we take too much acetaminophen, we run out of our glutathione,. That's what we classically think about as the pathophysiology of acute acetaminophen overdose. Aniongap acidosis in the setting of hepatic necrosis secondary to acetaminophen toxicity.