The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 64-year-old man with a significant medical history of chronic obstructive pulmonary disease, alcohol abuse, and depression presented to the intensive care unit as a transfer from an outside hospital for acute hepatic failure. The patient had ingested a large quantity of tablets in an attempted suicide 6 hours before arrival at the previous hospital.
His initial pertinent laboratory evaluation from the outside hospital was notable for the following:
Ethanol level: 320 mg/dL
Acetaminophen level: 430 µg/mL
Aspartate aminotransferase (AST) level: 2066 U/L
Alanine aminotransferase (ALT) level: 1321 U/L
Nonhemolyzed potassium level: 7.6 mEq/L
Creatinine phosphokinase (CPK) level: 62,530 IU/L
He was placed on a norepinephrine infusion and was intubated secondary to being obtunded. He underwent treatment for hyperkalemia, was started on intravenous N-acetylcysteine (NAC), and was transferred.
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Cite this: Gregory Taylor, Adam M. Vieder. Acute Liver Failure in a 64-Year-Old Man - Medscape - Mar 29, 2019.