In the ED, their vitals/exam are as above Differential includes cirrhosis, alcoholic hepatitis, congestive hepatopathy from CHF, Budd-Chiari, portal venous thrombosis, idiopathic portal fibrosis, malignancy, peritoneal TB, pancreatitis, serositis, intravascular volume depletion from LVP, SBP, sepsis, and nephrotic syndrome. Lower suspicion for non-hepatic, localized abdominal pathology given lack of acute distress/focal abdominal TTP. No current concern for abdominal compartment syndrome but will monitor closely.
– Labs/Tests: Rectal exam, Lactate, CBC, CMP, Lipase, PT/INR, Ammonia, Serum osms, Blood cultures, UA, Urine lytes (osms, sodium), Urine Culture, Diagnostic para w/ gram stain, cell count (WBC >1000, PMNs >250/uL), culture
– Imaging: CTAP
– Treatments: 25% Albumin 1g/kg. Low threshold for ceftriaxone 2g, Consider LVP/midodrine (7.5mg)/octreotide (50mcg/hr) as inpatient vs. Norepi to raise MAP
– Consults: GI as inpatient
– Dispo: Likely admission