2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M68_F3.jpg"}},{"insert":"\n\n"},{"insert":"On examination, his vital signs are stable. You note flapping tremors with arm extension. The cardio-respiratory examination reveals no abnormalities. Palpation of the abdomen is also unremarkable. The neurological examination reveals bilaterally diminished Achilles tendon reflexes. His gait is normal.\n\nEvaluation of Gideon\u0027s mental state shows him to be alert and oriented to person, place, and purpose. He seems mildly anxious, but is not agitated. There are no thought disturbances. His insight and judgement are intact. He does not appear to at risk of deliberate self-harm.\n\nA review of Gideon\u0027s laboratory studies (including his liver functions, full blood count, and coagulation profile) shows a picture consistent with early alcoholic liver disease. An ultrasound scan is supportive, showing a coarsened hepatic echotexture, without nodularity or features of portal hypertension.\n\nYou ask your intern to calculate his CIWA-Ar score. This amounts to 11 out of 67 points, i.e., moderate withdrawal. Because of this, you start oral diazepam. You also continue the ongoing management for his episode of alcoholic ketoacidosis.\n"}]}