zaki
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A 46-year-old woman with a 20-year history of alcohol abuse presents with abdominal discomfort, nausea, and vomiting. She states she had been drinking heavily (15 to 20 beers/day and a fifth of vodka every 2 days) and stopped yesterday morning when she noticed worsening right upper quadrant pain and nausea. She has noticed some mild abdominal pain for the past week. She has been vomiting frequently. She has not eaten a full meal for 7 days and had very little oral intake of any kind yesterday.
Physical examination reveals a thin, pale woman with a marked tremor. Her temperature is 36.8 °C (98.2 °F), pulse rate is 120/min, and blood pressure is 90/60 mm Hg. Her liver is palpable 6 cm below the right costal margin, with a span of 14 cm in the right midclavicular line, and the edge is tender.
Laboratory studies:
Hemoglobin 10 g/dL
Hematocrit 30%
Leukocyte count 12,000/µL
Mean corpuscular volume 104 fL
Serum electrolytes
Sodium 136 meq/L
Potassium 3.6 meq/L
Chloride 94 meq/L
Bicarbonate 16 meq/L
Aspartate transaminase (AST) 60 U/L
Alanine transaminase (ALT) 22 U/L
Glucose 150 mg/dL
Amylase 80 U/L
Alcohol 10 mg/dL
Abdominal ultrasound reveals an enlarged liver, a gallbladder without stones, and no dilated bile ducts. She receives intravenous thiamine, multivitamins, and benzodiazepines in the emergency room.
What further intravenous therapy is indicated?
(A) Sodium bicarbonate
B) Glucose and saline
C) Insulin
D) Beta-blockers
(E) Corticosteroids
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Maverick
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B.
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| guest
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A Sodium bicarbonate
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| alice8
Forum Guru
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C) Insulin
I think she is also suffering from pancreatic insufficency ..With that long starvation blood glucose level is high for this patient
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| no more a loser
Forum Guru
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Choice B: Glucose and saline
No need to give bicarbonate as her bicarb is 16 & case doesnt tell us about ABGs but doesnt seem too acidotic. Insulin is not required as her glucose is 150; beta blockers & steroids not indicated in her
Mostly alcoholics are given thiamine, D5W, saline, folate,vitamins
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| peace
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B) Glucose and saline
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| zaki
Forum Guru
Topics: 92
Posts: 398
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Answer: B
Educational Objective: Recognize and initiate proper therapy for alcoholic ketoacidosis.
This patient presents with abdominal pain, nausea, and vomiting. Physical examination and laboratory testing suggest alcoholic hepatitis. Alcoholic ketoacidosis is usually seen in the setting of binge drinking with cessation of food intake for an extended period and vomiting. It appears to be more common in women than in men. Hyperglycemia is inconsistent and may be present in diabetics or mildly present in nondiabetics. This patient’s slightly elevated glucose level makes diabetic ketoacidosis unlikely, and insulin therapy is not appropriate.
In a patient such as this, ingestion of other alcohols (ethylene glycol and methanol) should be considered, and it would be worthwhile to test for these alcohols.
Treatment of alcoholic ketoacidosis consists of rehydration with normal saline and intravenous administration of glucose. The ketosis will clear rapidly with therapy, and sodium bicarbonate usually is not indicated unless the acidosis is very severe. Beta-blockers have no place in this situation. Corticosteroids seem to benefit patients with severe alcoholic hepatitis but will not treat the acidosis
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Maverick
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