A previously well 38 yo man presents with a week of worsening vomiting, diarrhoea and abdominal pain. On the day of presentation to the ED he has become drowsy and confused.
T 37 degrees Celsius
PR 110/min
BP 120/80 mmHg
GCS 12 (E3,V4,M5)
His liver function tests are shown:
Bilirubin 100 umol/l (14-37)
ALP 152 U/L (20-105)
GGT 97 U/L (<31)
ALT 7355 U/L (<31)
AST 4583 U/L (<31)
Albumin 28 g/l (38-50)
Protein 65 g/l (65-85)
Glucose 2.0 mmol/l (4-6)
INR 2.1 (0.8-1.2)
APTT 38 sec (27-43)
Questions:
1. Describe the abnormalities
2. List the differential diagnosis
3. What is your treatment priorities?
Results from ACEM fellowship examination 2013.2