MSFinals-5185
A 23-year-old woman is admitted to the acute medical unit after intentionally overdosing on 60 paracetamol tablets over a period of 12 hours. She presents with abdominal pain and nausea and has a history of depression and anxiety. The patient is started on acetylcysteine treatment and is reviewed the following day. The blood results at 24 hours into admission show a pH of 7.29 (7.35 – 7.45), lactate of 1.9 mmol/L (0.9 – 1.6), paracetamol levels of 2 (< 3), creatinine of 155 µmol/L (55 - 120), prothrombin time of 18 secs (10-14 secs), ALT of 90 u/L (3 - 40), and bilirubin of 39 µmol/L (3 - 17). What is the next most definitive step in managing this patient?