Lab case 220

83 years old male has been brought to ED by his wife with fever, confusion and epigastric pain. He was seen by GP 2 days ago with fever and was diagnosed as having LRTI ( no antibiotics given ).  He has history of T2DM, HTN, and cholecystectomy 10 years ago.

His vitals are : HR 115, BP 105/70, temp 39. RR 22, sats 95 RA, GCS 14 ( confused). abdomen soft, mildly tender RUQ, and epigastrium.

Patient had VBG which was consistent with HAGMA . Electrolytes were normal, lactate 2.5, and Creatinine 125.  Patient had other blood tests done as part of workup and LFTs came back as following.

Bilirubin     67         (< 21)

ALP           320        ( 30 -110)

GGT           368        ( < 41)

ALT             248       ( < 36)

Q1: Interpret above Liver function tests ?

2. What is the most likely diagnosis with this clinical picture and LFTs?

3. What are the important considerations in management of this patient ?