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