A 35-year-old male is brought in by ambulance with an overdose of

paracetamol. He was found by neighbours alone in his unit. He had written a

suicide note that says he took 50 tablets of 500mg, dated 3 days ago.

On arrival, he is jaundiced. HR 105, BP 105/90, RR 24, Temp

36.1. He is unable to follow commands and is disorientated to time place and

person.

His pathology findings are:

• Bilirubin 82umol/L (1-20)
• ALT 3890 U/L (5-40)
• AST 7257 U/L (5-30)
• Alkaline phosphatase 178 U/L (30-110)
• Creatinine 0.30 mmol/L (0.60-0.11)
• INR 6.9 (< 1.5)
• Paracetamol level is 22 mg/L