A 20-year-old female pres...

A 20-year-old female presents to her local Emergency Department after being discovered in a drowsy state in her bedroom by a family member. According to her mother, she is typically in good health and was last seen 2 days ago. On examination, she appears very unwell, with a Glasgow Coma Score of 8. Her saturations are 95% on air, and she exhibits tachypnea at 35 breaths per minute. Additionally, she is tachycardic (140/min) and hypotensive (90/30 mmHg). Laboratory findings reveal a lactate level of 12 mmol/L and a blood glucose level of 2 mmol/L. Liver function tests show an alanine aminotransferase (ALT) of 10,360 iU/L, a Bilirubin of 54 umol/L, and an alkaline phosphatase (ALP) of 138 iU/L. Her white cell count is moderately elevated, and her platelet count is slightly low at 90 × 10^9/L. Furthermore, the international normalized ratio (INR) is markedly increased at 4.9. The Emergency Department clinicians have sought medical input and ask the following questions:

1. What is the most likely diagnosis?
2. What initial measures should be taken in the Emergency Department?
3. The ammonia level is reported as 230 umol/L; what is the resulting key concern, and what measures can you take to mitigate it?