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A 70 y/o male patient presents to the ED complaining of abdominal pain and hasn’t urinated in the past day despite drinking a large amount of water. After further questioning, he admits that he ingested about 40 tablets of 500mg Tylenol about 4 days ago as a suicide attempt but puked a few minutes later and believed to have puked it all out. However, during the week he developed upper right quadrant pain and now complains or oliguria. A SMA7 is ordered and the panel shows Na+ 137 Cl 102 HCO3 12 pH 7.09 CBGM 6mmols/L. Oriented x 3 with a past history of psychiatric admission, hypertension and elevated cholesterol. Vitals are stable other than a respiratory rate of 22 breaths/min.