Gastroenterology
Case 40: A Woman Who Drinks Heavily and Has Had a Seizure
CASE
A 34‐year‐old woman is admitted to your ward following a seizure. She admits to being a heavy drinker, consuming at least 2 litres of strong cider daily. She has been trying to cut down her alcohol intake because of persistent nausea and vomiting. Her only previous admissions to hospital were due to a head injury and an impulsive overdose. She takes no regular prescribed medications but admits to smoking tobacco and cannabis socially and previously to having used ecstasy. She has never used intravenous drugs.
On examination she is tremulous and sweaty. She is orientated and cooperative. She has a tachycardia with a pulse of 120 beats/min and has a hyperdynamic circulation with a bounding high volume pulse and relative hypotension (systolic BP 80 mmHg). She is jaundiced and febrile with a temperature of 38°C. Abdominal examination reveals some RUQ (right upper quadrant) tenderness and moderate hepatomegaly. She has no detectable spleen nor large volume ascites.
Blood tests showed:
Hb 9.4 g/dL WCC 16.4 × 109/L Platelets 78 × 109/L PT 20 sec Na 118 mmol/L K 2.3 mmol/L Urea 1.6 mmol/L Creatinine 98 µmol/L Albumin 24 g/L Bilirubin 240 µmol/L ALP 265 U/L ALT 358 U/L
On ultrasound her liver is enlarged with an irregular outline and heterogeneous echopattern. There is mild splenomegaly (12 cm) and small volume ascites. Reverse flow is noted in portal vein on Doppler.
QUESTION 1
Your score this session: 0 of 0
She feels like she is ‘having the DTs’ (experiencing withdrawal). Which of the following should you give her?