A 55-year-old man with cirrhosis due to alcoholic liver disease is admitted to the hospital with a large hematemesis. He has a history of ascites that has required prior hospital admissions. He has no history of hepatic encephalopathy or other comorbid conditions. Current medications are furosemide (40 mg daily) and spironolactone (100 mg daily).
The patient is alert and oriented. His blood pressure is 79/50 mm Hg, his heart rate is 118 bpm, and he has no fever. He has features of chronic liver disease including multiple spider naevi on the thorax and palmar erythema, but no asterixis. Heart and lung examination are normal. His abdomen is distended with non-tense ascites. The patient's score on the Model for End-Stage Liver Disease (MELD) is 22.
Laboratory studies:
| Hemoglobin |
10g/L |
[13-17 g/L] |
|
| Platelet count |
68,000/mm3 |
[150,000–450,000] |
|
| INR |
2.1 |
|
|
| Serum creatinine |
1.3 mg/dL |
[0.7–1.5] |
115 µmol/L (IU) |
| Serum total bilirubin |
2.2 mg/dL |
[0.3–1.0] |
38 µmol/L (IU) |
| Serum sodium |
133 mEq/L |
[136–145] |
133 µmol/L (IU) |
