Case 1 – update 1

Thanks for all your requests for more information!

The gentleman regained consciousness before the ambulance crew arrived and is now GCS 14 – he remains confused and is unsure of how he came to be in hospital.  He says he feels fine and wants to go home, and denies any past medical history or use of medications. He denies a high alcohol intake but is becoming quite agitated and you suspect the history you are getting from him is likely to be inaccurate.

Observations on admission show a tachycardia of 111bpm, BP 92/65, RR 13, sats 97% on room air and apyrexia. A&E noted that the gentleman looked a little dishevelled, cachectic and has spider naevi across his chest. They also noted a soft flow murmur.

Other blood results as requested:

Hb36g/L, MCV 139fL, WBCs 7.2×10*9/L, Plts 153×10*9/L, Retics 42×10*9/L, DAT negative

Na 132 mmol/L, K3.1 mmol/L, Urea 8.8 mmol/L, Creatinine 58 umol/L,

Bilirubin 32 umol/L, ALT 64 U/L, ALP 32 U/L

LDH 267 U/L, Urate 432 umol/L, Haptoglobins in progress

CRP 19 mg/L

ferritin 453ng/ml

TFTs in progress

ESR in progress

Blood film:image.png1 - 1.jpg

What do you think of the blood results and the film? (apologies for the background marks which are artefact). Are there any further tests you would like to request at this point?

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