Case 34: Introduction

History of Present Illness (HPI)

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A 54 year old woman with non-alcohol steatohepatitis (NASH) cirrhosis, type 2 diabetes mellitus, hypertension,  obesity is admitted to the hospital due to worsening ascites and altered mental status for 1 day  History is obtained from the patient’s daughter due the patient’s AMS.

Her daughter tells you that her mother did not have any fever, nausea, vomiting, abdominal pain, bleeding, or urinary symptoms that she noticed.  She is adherent with her medications which include spironolactone, sitagliptin, amlodipine, lactulose, rifaximin and a zinc supplement. She was recently started on pantoprazole. She has not used any other medications or supplements. She had been eating and drinking normally until yesterday.

Of note, her serum creatinine was 0.7 mg/dL last week. Her weight is 60 kg.

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