Authors: Ruth Watson / Editor: Steve Corry-Bass / Reviewer: Tom White / Codes: ACCS LO 2, EnP3, GC2, GP2, GP3, GP7, IP3, MHC1, SLO1, SLO2 / Published: 30/08/2022
A lady in her 50’s, who is a known alcoholic with cirrhosis, presents with a 3 day history of intermittent confusion, abdominal pain and distension. She was brought by ambulance to Emergency Department (ED), on assessment by the paramedics she was found to have a blood sugar of 0.9 which was treated with IM glucagon and glucogel.
On initial assessment she is jaundiced, alert but confused and agitated. Bilateral breath sounds Sats 94% RR 24. Heart sounds are normal, rate 122 sinus tachycardia on her ECG. Tense abdominal distention, jaundice, bedside USS demonstrated free fluid ++, temperature 35.9.
Bloods:
- WCC 26.7 (4-11) x109/L
- Hb 100 (115-165) g/L
- Neutrophils 23.2 (2-7.5) x109/L
- Platelets 394 (150-450) x109/L
- Na+ 126 (136-145) mmol/L
- K+ 6.0 (3.5-5) mmol/L
- Cl– 86 (100-108) mmol/L
- Urea 11.8 (2.5-6.4) mmol/L
- Creatinine 161 (100-120) μmol/L
- eGFR 29
- Bilirubin 51 (3-17) μmol/L
- ALT 67 (12-78) U/L
- ALP 380 (50-136) U/L
- GGT 359 (15-85) U/L
- Albumin 13 (35-50) g/L
- CRP 293 (2) nmol/L
- INR 1.8 (0.9-1.3)
- APTT 1.33 (27-42) s
- Fibrinogen 3.4 (1.9-8) g/L
- Blood sugar 1.2 (4-7.8) mmol/L
- Ammonia 345 (11.2-34.5) μmol/L
- Ethanol [not detected]
- Lactate 1.9 (0.5-2) mmol/L
CT Abdomen – cirrhotic liver, free fluid, ruptured dermoid cyst. Bowel nil pathology.