Today we discussed a case of a patient with jaundice from decompensated cirrhosis with encephalopathy, hepatorenal syndrome, and likely spontaneous bacterial peritonitis, who had a decreased level of consciousness.
The presumed etiology was ETOH cirrhosis with possible co-morbid hemochromotosis (NEJM review and recent study). Hemochromotosis is suggested when the transferrin saturation is above 45% (NB: in liver failure the transferrin levels may be low, artificially increasing the iron saturation) and/or the ferritin is above 200 in women and 300 in men.
There is a complex interplay between ETOH and iron overload with the two compounding to cause liver dysfunction as suggested in this article.
We also briefly noted the association between increased IgA and alcoholic liver disease.
He also had a traumatic subdural hematoma which needed to be urgently decompressed.
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