Sporadic

A 4 year old girl presents following multiple episodes of vomiting and confusion over a 4 hour period.

She had a ‘flu-like' illness 5 days ago, and still continues to experience a low grade fever. Her mother had treated this using an over the counter formulation containing Aspirin.

Her medical history is unremarkable, and all immunizations are up to date.

A complete blood count, serum electrolyte assay, arterial blood gas assay, and noncontrast CT brain are all found to be normal.

Select Relevant Investigations
Random Plasma Glucose

Performed

54 mg/dL (60-100)
Liver Profile

Performed

S. Albumin: 4.6 g/dL (3.9-5)
S. Bilirubin: 0.7 mg/dL (<1)
AST: 850 U/L (<50)
ALT: 1270 U/L (<40)
Prothrombin time: 20s (11-15)
S. Ammonia: 243 mmol/L (17-68)
Lumbar Puncture

Performed

You remember that lumbar puncture is best avoided in patients with a coagulopathy.
Liver Biopsy stat

Performed

You recall that liver biopsies are contraindicated in patients with a deranged prothrombin time.

Select Relevant Management
IV 10% Glucose
Fresh Frozen Plasma
ICU Care
IV Antibiotics