A 38-year-old woman is hospitalized for new-onset confusion and jaundice. She noticed a yellowish discoloration of the eyes 4 days before admission. Six weeks ago she developed sinus infection symptoms that were treated with amoxicillin-clavulanate. She has no history of liver disease. She does not drink alcohol or use illicit drugs or herbal supplements. She is now taking no medications.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 118/82 mm Hg, pulse rate is 72/min, and respiration rate is 20/min; BMI is 27. She appears ill and is disoriented to time and date. Asterixis, scleral icterus, and jaundice are noted. Examination is negative for spider angiomata, palmar erythema, muscle wasting, and rash. The liver edge is palpable 2 cm below the costal margin. The spleen is not palpable.
INR | 1.9 (normal range 0.8-1.2) |
Prothrombin time | 28 s |
Alanine aminotransferase | 199 U/L |
Aspartate aminotransferase | 398 U/L |
Total bilirubin | 9.5 mg/dL (162.5 µmol/L) |
Creatinine | 1.2 mg/dL (106.1 µmol/L) |
Serologic studies for hepatitis A IgM, hepatitis B surface antigen, hepatitis B core IgM, Epstein-Barr virus, cytomegalovirus IgM, antinuclear antibody, anti–smooth muscle antibody, and ceruloplasmin are all negative. The serum acetaminophen level is 0 µg/mL. A pregnancy test is negative.
In addition to evaluation for liver transplantation, which of the following is the most appropriate treatment?