A 44 year old man presents 12 hours following a Paracetamol overdose. He feels unwell with epigastric pain and nausea.

His blood results show:Paracetamol level < 1

Bilirubin 22  (<21 umol/l)

ALP  97  (35-110 U/L)

GGT  64  (<51 U/L)

ALT  9560  (<56 U/L)

Alb  37  (38-50 g/l)

INR  1.7 (0.8-1.2 sec)

Na  138  (134-146 mmol/l)

K  3.9  (3.4-5.5 mmol/l)

Cl  105  (99-111 mmol/l)

HCO3  28  (22-26  mmol/l)

Urea  8.9  (3-8  mmol/l)

Creat  152  (40-120 umol/l)

Describe and Interpret the abnormailities

What are the clinical phases of Paracetamol toxicity?