Author: Jessie Lynch / Editor: Yasmin Sultan / Codes: GC6, GP7, GP9, PhC1, PhC4, PhP2, PhP3, SLO1, SLO3Published: 22/10/2022

A 27-year-old female has a 5 day history of myalgia & pyrexia, and has been self-medicating with paracetamol and Lemsip. Over the last 48 hours she has developed nausea, vomiting and right upper quadrant pain. Today she is drowsy and disoriented.

On examination she is slightly drowsy and oriented to person and place but not time. She has scleral icterus and is tender in her right upper quadrant.

Observations:

  • Temperature 37.8ºC
  • HR 122
  • BP 101/58
  • RR 26
  • SpO2 100% on room air

Arterial Blood Gas (ABG):

  • pH 7.303, pCO2 3.3, pO2 14.3, HCO3- 14, Na+ 135, K+ 5.1, Cl- 96, lactate 4.3

Bloods:

  • Total bilirubin 60µmol/L (<21)
  • ALP 432U/L (30-130)
  • GGT 1171U/L (<60)
  • ALT 2657U/L (<41)
  • AST 2893U/L (1-45)
  • Urea 11.4mmol/L (2.5-7.8)
  • Creatinine 177µmol/L (45-84)
  • INR 1.9 PT 72 seconds (10-14)