A 51 year old man is brought to your ED by his family. He has been slightly confused and also had diarrhoea and vomiting for the last three days.
The patient drinks about 3 litres of vodka per day. He has recently been started on Desvenlafaxine for depression.
He also has some visual hallucinations
On examination he looks jaundiced.
Vitals:
BP 90/60
PR 120/min
Blood Results:
Hb 144
Platelets 141
WCC 12.4
Neutrophils 9.5
Bilirubin 94 (<21 umol/l)
ALP 227 (35-110 U/L)
GGT 1032 (<51 U/L)
ALT 161 (<56 U/L)
Albumin 33 (38-50 g/l)
TP 64 (65-85 g/l)
Na 131 (134-146 mmol/l)
K 2.8 (3.4-5.5 mmol/l)
Cl 80 (95-108 mmol/l)
HCO3 31 (22-32 mmol/l)
Urea 12.9 (3-8 mmol/l)
Creat 147 (40-120 umol/l)
CRP 60
AST 298 (<41 U/L)
Questions:
- Describe the blood results
- Interpret
- What examination findings would assist in your asssessment of this patient
alcoholic hepatitis with AST: ALT almost 2:1.
hypokalemia hypochloremia secondary to vomiting and dehydration; likely associated metabolic all (hco3 is 31) but pH not given.
Useful examinatins findings would be – RR, temp, features of CLD, volume status (likely dry), glucose, ketones.
Needs RX isotonic hydration, thiamine, K replacement +/- glucose, benzos by AWS, analgesia.
further Ix needed is Coag profile Lipase and biliary US.
use of benzo’s in patients with liver failure/ cirrhosis?