27 Oct The patient was a 48-year-old man with a history of former drug abuse who presented to the emergency room with abdominal swelling, lethargy, anorexia, and hemoptysis

Case 5 The patient was a 48-year-old man with a history of former drug abuse who presented to the emergency room with abdominal swelling, lethargy, anorexia, and hemoptysis. On physical examination, he was noted to have mild ascites and was somewhat obtunded. The following labs were ordered and resulted: Studies Results Sodium 138 mEq/L (normal:132 – 144 mEq/L) Potassium 4.7 mEq/L (normal: 3.4 – 5.1 mEq/L) Chloride 107 mEq/L (normal: 101 -111 mEq/L) Carbon Dioxide 23 mEq/L (normal: 22 – 32 mEq/L) BUN 13 mg/dl (normal: 8 – 22 mg/dl) Creatinine 1.0 mg/dl (normal: 0.4 – 1.0 mg/dl) Glucose 163 mg/dl (normal: 70 – 125 mg/dl) GFR >90 ml/min/1.73m- (normal) Albumin 1.8 g/dl (normal: 3.5 – 5.0 g/dl) Calcium 8.6 mg/dl (normal: 8.9 – 10.3 mg/dl) Phosphate 2.5 mg/dl (normal: 2.3 -4.1 mg/dl) Magnesium 2.1 mEq/L (normal: 1.5 – 2.5 mEq/L) Anion Gap 8 mmol/L (normal: 1 – 13 mmol/L) Osmolality 279 mOsmo/kg (normal: 275 – 300 mOsmo/kg) ALT 178 International units/L (normal: 5-35 International units/L) ALP 130 units/L (normal: 30-85 units/L) AST 176 International units/L (normal: 5-40 International units/L) LDH 240 International units/L (normal: 45-90 International units/L) GGT 33 International units/L (normal: 8-38 International units/L) Ammonia 348 mg/dL (normal 15-110 mg/dL) Computed tomography (CT) Shrunken fibrotic liver compatible with cirrhosis scan of liver Hepatitis profile, p. 256 All negative, except HBVc-Ab Esophagoscopy, p. 547 Esophageal varices Case 5 Questions 1. Discuss the indications for ordering these labs; why would the medical team order these labs? Why is his NH elevated? What are your thoughts on a diagnosis for this patient? What other information would you want to obtain?