After a Wild Party, a 24-Year-Old Has Intense Abdominal Pain

Marie-Lee Simard, MD; Alexandre Lafleur, MD, MSc

Disclosures

July 08, 2021

Physical Examination and Workup

Upon examination, the patient is in no apparent distress. Vital signs include a blood pressure of 152/94 mm Hg, a regular pulse of 57 beats/min, a respiration rate of 20 breaths/min, and a rectal temperature of 98.4°F (36.9°C). His oxygen saturation is 100% on ambient air.

He lies comfortably in bed at rest, but mobilization elicits the abdominal pain. The abdomen appears normal, without gross distension. Normal bowel sounds are audible. Significant abdominal tenderness is present in the right lower quadrant, without guarding or rebound tenderness. The abdominal wall and groin examination reveals no bulging mass. Percussion of the right costovertebral angle provokes mild discomfort. Heart sounds are normal, lungs are clear, and no pedal edema is noted. The skin appears normal, without signs of vasculitis. The rest of the physical examination findings are unremarkable.

The laboratory findings are notable for a creatinine level of 123 µmol/L (reference range, 55-105 µmol/L), with an estimated glomerular filtration rate (eGFR) of 69 mL/min/1.73 m2 (reference range, > 60 mL/min/1.73 m2). No previous creatinine levels are found in the patient's medical record. The serum lactate dehydrogenase (LDH) level is 2093 U/L (reference range, < 225 U/L).

Other laboratory results are as follows:

  • White blood cell count: 11.8 × 109 cells/L (reference range, 4.8-10.8 × 109 cells/L)

  • Hemoglobin level: 156 g/L (reference range, 140-180 g/L)

  • Aspartate aminotransferase level: 426 U/L (reference range, < 45 U/L)

  • Alanine aminotransferase level: 304 U/L (reference range, < 60 U/L)

The bilirubin level is within the normal range, as are levels of lipase, creatine kinase, and lactic acid. A blood gas analysis reveals no metabolic acidosis. A urinalysis shows no hematuria, leukocytes, or nitrites but reveals mild proteinuria with a protein/creatinine ratio of 0.068 g/mmol (reference range, < 0.015 g/mmol). Troponin levels and an ECG are normal.

An abdominal and pelvic ultrasound scan is performed, followed by a noncontrast abdominal and pelvic CT scan. The liver, gallbladder, kidneys, and appendix all appear normal.

The patient is treated with intravenous fluids for hydration, opioids for pain control, and ondansetron for nausea.

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