Biology of Disease

X]VeiZg&'/ TOXICOLOGY

W^dad\nd[Y^hZVhZ

CASE STUDY 12.1

Helen, an 18-year-old, was admitted to the Accident

and Emergency Department of her local hospital. She

was found in her bedroom with an empty bottle of

aspirin tablets. On admission, Helen was in a confused

state, sweating and breathing heavily. There was clinical

evidence for mild dehydration. She had a pulse rate of

112 per min and blood pressure of 110/70 mmHg. Her

body temperature was 39oC. Laboratory investigations

give the following profile (reference ranges are shown in

parentheses).

Na+ 132 mmol dm–3 (135–145 mmol dm–3)

K+ 3.4 mmol dm–3 (3.6–5.0 mmol dm–3)

HCO 3 – 11 mmol dm–3 (22–30 mmol dm–3)

Urea 11 mmol dm–3 (3.3–6.7 mmol dm–3)

Glucose 3.5 mmol dm–3 (2.8–6.0 mmol dm–3)

Salicylate 4.6 mmol dm–3 (up to 2.5 mmol dm–3 is

therapeutic)

pH 7.20 (7.36–7.44)

PCO2 3.6 kPa (4.5–6.0 kPa)

Prothrombin time 18 s (14 s)

Questions

(a) What can be concluded from the clinical data?

(b) What treatment would be suitable?

CASE STUDY 12.2

Olga, a 25-year-old, was admitted to hospital after being

found unconscious by her flatmate. It was reported that

empty vodka and paracetamol bottles had also been

discovered in her flat. On admission to an Accident and

Emergency Department, Olga’s breath smelt of alcohol

and her serum paracetamol concentration was 105 mg

cm–3. Her liver function tests were normal as was the

prothrombin time. Her serum alanine aminotransferase

levels showed a transient increase over the next few days

but gradually fell back within the reference range.

Questions

(a) Comment on these clinical findings.

(b) What treatment should Olga be given?

CASE STUDY 12.3

Ed is a building site worker aged 58 who has been a heavy

drinker for over 30 years. He was admitted to hospital

after collapsing outside a public house. He smelt strongly

of alcohol, was confused and unsteady on standing. He

complained of fatigue, nausea, particularly early in the

morning, and a loss of appetite. A physical examination

detected abdominal tenderness and enlargement of

the liver and gastrointestinal varicose veins. His blood

alcohol concentration was 79 mmol dm–3.

Maureen aged 52 was admitted into hospital at a similar

time. She presented with general GIT problems and

frequent diarrhea. She was subjected to considerable

stress at work and admitted she had been drinking ‘rather

heavily’.

Ed’s Ca2+ and Mg2+ blood concentrations were low and

his clotting time extended. His urinary urea excretion

was also subnormal. Liver function tests were performed

on sera from both patients. The results are shown below

(reference ranges are shown in parentheses).

Ed Maureen

Total protein / g dm–3 67 78 (60–84)

Albumin / g dm–3 31 39 (35–50)

Total bilirubin 57 14 (3–15)

Alkaline phosphatase /

U dm–3 720 335 (100–300)

Alanine transaminase / 34 91 (5–35)

U dm–3

Aspartate transaminase / 41 162 (10–40)

U dm–3

G-glutamyltransferase / 780 455 (7–45)

U dm–3

Questions

(a) Suggest why the tests above are particularly

indicative of the state of the health of the liver.

(b) Does Ed or Maureen show the greater liver

degeneration?

X]VeiZg&'/ TOXICOLOGY

()% W^dad\nd[Y^hZVhZ