CASE 21: A 32 YEAR OLD MAN IN AN UNRESPONSIVE STATE

Patients Profile
A Demographic Data
Name:
Address:
Age:
Gender:

32 years old
Male

Civil Status:
Occupation:
Nationality:
Religion:
Admitting Diagnosis:
Final Diagnosis:
virus infection

Acute liver failure with an unclear cause

Fulminant liver failure associated with hepatitis

Date and time of Admission:

B Chief Complaint
The patient was found in an unresponsive state.
`C. History of the Present Illness

Nausea and vomiting 2 days PTA

Prescribed with Acetaminophen 650 mg up to three times daily PRN
Acting strangely few hours PTA
Found in an unresponsive state in his jail cell
Decerebrate posture and incontinent of urine
Vital signs : BP = 170/119 mmHG; PR = 112 bpm; T = 36.9
Intravenous dextrose and lorazepam were administered
Endotracheal intubation was performed

D. History of the Past Illness

Substance-use disorder (alcohol, opiates and cocaine)

Traumatic brain injuries
Seizures
Anemia
Diagnosed of Paranoid Schizoprenia
Test for HBV surface antibodies resulted positive six years ago
Subdural Hematoma (14 months PTA)
Orbital, nasal and jaw fractures (14 months PTA)

CASE 21: A 32 YEAR OLD MAN IN AN UNRESPONSIVE STATE

8 months PTA, elevated ammonia level, ultrasonography revealed

evidence of liver fibrosis and a fatty liver

E. History of Family Illness

Unavailable
Has been homeless

F. Social History

Smoked one pack of cigarettes daily for the past 15 years

Drunk several pints of vodka daily before incarceration
Used intranasal cocaine and heroin

G. Allergies
N/A

H. Assessment
Vital signs:
BP = 170/119 mmHg
PR = 112 bpm
T = 36.9
1 Physical assessment
Skin

Skin was jaundiced in color.

Eyes

Pupils were equal in size; Right pupil reacted to light more

slowly than the left pupil; sclera is yellow in color

Chest
Abdome
n
Extremit
ies

Systolic murmur was heard on auscultation

Mildly distended
Extensor posture of the arms; myoclonic jerking movements of
the legs