A 25-year-old female presents with a 2-day history of nausea and upper abdominal pain. She is a previously well lady with no significant medical history. However, she has had a severe toothache for 1 week and has been taking painkillers for 1 week.
Examination reveals that she is slightly jaundiced. Her blood pressure is 80/50 mm Hg, HR 105, GCS 15. Temperature 37.5
Blood tests reveal the following results
|
Na |
138 mmol/l |
(135 – 145) |
|
K |
3.9 mmol/l |
(3.5 – 5) |
|
Cl |
108 mmol/l |
(97 -109) |
|
Bicarbonate |
20 mmol/l |
(24-32) |
|
Urea |
2.6 mmol/l |
(3 – 8) |
|
Creat |
130 micromol/l |
(50 – 90) |
|
Bilirubin |
80micromol/l |
(0-18) |
|
Albumin |
38 g/l |
(36-48) |
|
ALP |
81 U/L |
(30 – 130) |
|
ALT |
1840 U/l |
(5 – 55) |
|
AST |
1220 U/l |
(5 – 55) |
What abnormalities do these investigations show and what are the possible causes?
The rest of the questions focussed on the management of subacute/chronic paracetamol toxicity.
Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.