A 35-year-old female with no known previous medical history presents to the emergency department with a decreased conscious level.
The following results are obtained
Venous Biochemistry |
|||||
Parameter |
Patient Value |
Normal Adult Range |
|||
Sodium |
144 mmol/L |
135 – 145 |
|||
Potassium |
4.0 mmol/L |
3.5 – 4.5 |
|||
Chloride |
100 mmol/L |
95 |
– |
105 |
|
Bicarbonate |
14 mmol/L* |
22 |
– |
26 |
|
Glucose |
1.1mmol/L* |
3.5 – 6.1 |
|||
Urea |
2.7 mmol/L |
2.9 – 8.2 |
|||
Creatinine |
120 μmol/L |
70 |
– |
120 |
|
Albumin |
46 g/L |
35 |
– |
55 |
|
Total bilirubin |
90 μmol/L* |
< 20 |
|||
Alkaline phosphatase (ALP) |
131 U/L* |
36 |
– |
92 |
|
Aspartate aminotransferase (AST) |
2450 U/L* |
< 40 |
|||
Gamma glutamyl transferase (GGT) |
50 U/L* |
< 30 |
|||
Alanine aminotransferase (ALT) |
2750 U/L* |
< 35 |
|||
Coagulation Tests |
|||||
Parameter |
Patient Value |
Normal Adult Range |
|||
PT |
45 sec* |
12 |
– |
16 |
|
APTT |
46 sec* |
25.0 |
– 37.0 |
||
Fibrinogen |
0.2 g/ L* |
2.20 |
– 4.30 |
a) Give one diagnosis which will explain the clinical and laboratory findings. (10% marks)
b) List six possible aetiologies. (20% marks)
a)
b)
Well, you can't call it "acute liver failure" or "hyper-acute" or subacute" because these have specific time intervals as definitions. All you can really say is that there is liver failure. The college gives malingant infiltration as a differential, which gives one the impression that they would be willing to consider the more insidious causes of liver damage.
Possible categories of the causes:
Vascular:
Infectious:
Neoplastic:
Drug-induced:
|
Idiopathic: idiosyncratic drug reactions:
Congenital:
Autoimmune:
Traumatic:
Endocrine/metabolic:
|