Mohmed:
Do not let the clinicians ignore the elevated cTnI just because the CK,
CKMB, and ECG are normal. The autopsy will reveal an old infarction. Hugely
elevated transaminases and LD are NOT consistent with normal liver function.
Insist on an acetaminophen level (codeine/acetaminophen combinations are
common), identify the opiate, and watch this patient very closely.
Coagulopathy is a delayed response in acetaminophen hepatotoxicity, but it
progresses rapidly and is often fatal. I am not familiar with "NPEBP," but
if it refers to B-type natriuretic peptide, then the result is consistent
with a severly compromised myocardium. Whatever this patient's clinical
signs suggest, he is in serious trouble and needs immediate, intensive care.
Roger
Roger L. Bertholf, Ph.D.
Associate Professor of Pathology
Director of Clinical Chemistry & Toxicology
University of Florida Health Science Center/Jacksonville
-----Original Message-----
From: Mohmed Ashmaig
To: [log in to unmask]
Sent: 2/16/04 6:50 PM
Subject: Case for discussion
Dear All,
55 years old male visited our emergency department
last night with short of breath, and NO other clinical
conditions.
His ECG, renal function were normal. His liver
function were normal except ALT 3726, AST 1926.
His cardiac marker were as follow, normal CPK and
CK-MB, LDH 3374 U/L, Troponin I from DPC immulite 2.8
(0.0-1.0 the normal range), NPEPB 718 ( normal 5-76
pg/ml).
The haematology side results were normal except his
HGB of 11 gm/dl and high Reticulocyte count, PT and
PTT are normal.
His urine drug of abuse screening were positive for
opiate.
The doctor thinking of drugs liver toxicity....
But I think the effect of drugs of abuse on heart
muscles cells.
Any one can suggest any further investigations to be
done...
What could be wrong with this patient....
Thanks to all in advance
Mohmed
USA
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