A 72 year old male presents to the emergency department with confusion. He lives alone at home, and was found by his daughter who called EMS. He was last seen well one week ago. On exam, he appears jaundiced and has asterixis. His blood work shows ALT and AST levels > 10,000 IU/L, total bilirubin of 77, lactate of 7.2. His daughter at the bedside states that she found empty bottles of acetaminophen at the patient’s home. What stage of acetaminophen poisoning is this patient in?