The previous SAQ, Question 24.1, presents the first part of the history:
"A 27-year-old patient was found unresponsive with no signs of life. Two rounds of CPR were performed prior to ROSC. A laryngeal mask (LMA) was placed en route to hospital."
The ABG presented in that SAQ demonstrated a severe respiratory acidosis with a PaCO2 of 192, severe metabolic acidosis with a lactate of 18, renal failure, and profound hypoglycaemia.
The same patient has another cardiac arrest in the Emergency Department with 2 minutes CPR and adrenaline administered. The patient is now intubated, ventilated and arrives to ICU on an adrenaline infusion. Subsequent results are available.
Parameter |
Patient Value |
Adult Normal Range |
Albumin |
32 g/L* |
35 – 50 |
Protein |
50 g/L* |
60 – 80 |
Total bilirubin |
11 μmol/L |
< 26 |
Alanine transferase |
10200 U/L* |
< 35 |
Aspartate transferase |
9200 U/L* |
< 35 |
Alkaline phosphatase |
164 U/L* |
30 – 110 |
γ-Glutamyl transferase |
251 U/L* |
< 40 |
Ammonia |
555 μmol/L* |
11 – 32 |
Parameter |
Patient Value |
Adult Normal Range |
Prothrombin time |
18.0 secs* |
12.0 – 16.5 |
International Normalised Ratio |
2.0* |
0.9 – 1.3 |
Activated Partial Thromboplastin Time |
66.2 secs* |
27.0 – 38.5 |
Fibrinogen |
1.6 g/L* |
2.0 – 4.0 |
Parameter |
Patient Value |
Adult Normal Range |
Haemoglobin |
100 g/L* |
120 – 160 |
White Cell Count |
18.5 x 109/L* |
4.0 – 11.0 |
Platelet count |
36 x 109/L* |
150 – 350 |
a) Explain the abnormalities and the likely causes. (25% marks)
Not available.
In detail, the abnormalities are:
Bernal, William, et al. "Acute liver failure." The Lancet 376.9736 (2010): 190-201.
Rolando, Nancy, et al. "The systemic inflammatory response syndrome in acute liver failure." Hepatology 32.4 (2000): 734-739.
Ellis, Antony, and Julia Wendon. "Circulatory, respiratory, cerebral, and renal derangements in acute liver failure: pathophysiology and management." Seminars in liver disease. Vol. 16. No. 4. 1996.