Case 1

A 63-year-old female presents to the ED. She looks unwell and unkempt. Observations are:

• 120 bpm
• Temp 37.5°C
• BP 92/54 mmHg
• Sats 93%

She is cachexic and smells strongly of alcohol. She is drowsy but is able to protect her airway.

What are your initial actions?

Routine blood results show: AST 68, ALT 152, GGT 76, plts 88, Hb 91, MCV 105.

Rank the following diagnoses into order of likelihood for this patient, from most appropriate (1st) to least appropriate (4th):

You discover that your patient is known to a hostel, and drinks several bottles of cider per day. Septic screen is negative. She is diagnosed with probable alcoholic hepatitis.

What is your next course of action?