CASE #6

HISTORY

The patient is a 38 year old female who presents with a history of nausea, vomiting, and jaundice. She admits to chronic ethanol abuse and ingestion of "a whole bottle-full of extra-strength Tylenols" for her "pancreatitis pain" over a several hour time frame, three days prior.

PHYSICAL

• General: Appears older than her stated age, in moderate distress
• Vitals: P=120 BP=90/60 RR=32 T=100.1
• HEENT: PERRL, EOMI, sclera icteric
• Lungs: CTA
• Ht: RRR S1S2, 2/6 systolic murmur
• Abd: (+)RUQ, midepigastric tenderness, (+)Hepatomegaly
• Rectal: (+) stool
• Ext: (-)c/c/e good periph pulses
• Neuro: Nonfocal
• Skin: Jaundiced, poor turgor

DIAGNOSTIC STUDIES

• CBC: WBC=15.4 H/H=9/27 PLT=120K
• Lytes: Na=138 K=3.2 Cl=103 HCO3=22
• BUN/Cr: 33/2.9 Glu=80
• SGOT/SGPT: 5620/4210
• Bili(total): 8.4
• PT/PTT: 49/79
• ETOH: 30
• APAP: 29 mcg/ml
• ASA: 0

Toxin and Discussion References