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An ATP-Depleting Futile Cycle Can Explain Acetaminophen-Related 5-Oxoproline Accumulation The critical missing step that can explain why chronic acetaminophen generates 5-oxoprolinemia/5-oxoprolinuria is shown in Figure 4

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This dose increases serum levels of -hydroxybutyrate by as much as 4 mM, similar to the level seen after two weeks of starvation, four times greater than what is seen after several weeks of a ketogenic diet, and up to 40 times higher than what is seen following an overnight fast, with levels returning to baseline after approximately 4 h [25]