Thursday, July 05, 2007

Yellow fellow

Some of newFNP's more diligent readers might be wondering what, in fact, happened with Mr. Alcoholic Hepatitis. Perhaps some are even wondering what in the world they might do if they found themselves with a similar patient.

Well, wait no longer because newFNP's boyfriend is out of town, the David Sedaris article in this week's NYer is read and newFNP is therefore here with all of the answers. OK, maybe two or three of the answers.

The single most important intervention is complete and total abstinence from alcohol. Bo-ring! NewFNP recommended this several times to her young patient and, as previously noted, referred him to AA. She gave him a multi-vitamin because who can get their 5-9 servings of fruits & veggies if they are chug-a-lugging beer after beer?! And she checked his liver enzymes and acute hep panel, just to be on the safe side. What else could newFNP do? If newFNP worked in a fancy clinic, she would have ordered an ultrasound and perhaps even a liver biopsy. But newFNP works in a not-so-fancy clinic so her patient's visit was much more low tech.

No acute hepatitis - nope, this sad state of affairs was brought on by good old fashioned boozing. His liver enzymes showed - no surprise here - elevated AST and ALT. They weren't off the hizzie, however, just 193 and 110 respectively. But his bilirubin - holy toledo! Normal values max out at 1.4 mg/dL and jaundice is typically diagnosed at 2.5-3 mg/dL. Homeboy was rocking a bili of 24.3. Good day sunshine!

He is scheduled to come in on Saturday. NewFNP hopes that his eyes are no longer the color of a highlighter pen when she next sees him.

For those clinical die-hards out there, click here for an article about jaundice in the adult. God, it's a fascinating read. It's as good as Judy Blume's Wifey.

1 comment:

Nurse Practitioners Save Lives said...

Thanks for the link to the article! I am enjoying getting caught up with your blog now that I am finished with school. I have survived my first week of work and am loving it!