A 4 year old girl presents following multiple episodes of vomiting and confusion over a 4 hour period. She had a ‘flu-like' illness 5 days ago, and still continues to experience a low grade fever. Her mother had treated this using an over the counter formulation containing Aspirin. Her medical history is unremarkable, and all immunizations are up to date. A complete blood count, serum electrolyte assay, arterial blood gas assay, and noncontrast CT brain are all found to be normal.
54 mg/dL (60-100)
S. Albumin: 4.6 g/dL (3.9-5) S. Bilirubin: 0.7 mg/dL (<1) AST: 850 U/L (<50) ALT: 1270 U/L (<40) Prothrombin time: 20s (11-15) S. Ammonia: 243 mmol/L (17-68)
You remember that lumbar puncture is best avoided in patients with a coagulopathy.
You recall that liver biopsies are contraindicated in patients with a deranged prothrombin time.