Emergency and Toxicologymiddle twist
A 19-year-old man presents six hours after an acute ingestion of an unknown number of immediate-release paracetamol tablets in a suicide attempt. He is alert, with nausea and one episode of vomiting, and examination is unremarkable. His serum paracetamol concentration taken on arrival, six hours post-ingestion, is 128 mg/L (847 micromol/L), and alanine aminotransferase is 22 U/L (reference <40). Which one of the following is the most appropriate next step in management?