Problem:
A 78-year-old male with a past medical history of dementia and CVA with right-sided paralysis presents to the ED from the nursing home with hypotension, tachycardia, and altered mental status from baseline. CT of brain negative for new acute abnormalities. Labs with a leukocytosis of 25K, metabolic acidosis, and AKI. Chest x-ray concerning for right lower lobe pneumonia (RLL PNA). Started on broad spectrum antimicrobial therapy and intubated in the ED for airway protection. He was volume resuscitated adequately with normal saline, but remains hypotensive, so vasopressors started and transferred to the ICU for further critical care management of septic shock. Upon transfer, develops pulseless electrical activity (PEA) arrest from a severe metabolic acidosis with return of spontaneous circulation after 10 minutes. Stat echocardiogram revealing of acute biventricular heart failure. Over the next few days, he has a rapid continual increase in his aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate acid dehydrogenase (LDH) with an ALT greater than 1,000 mg/dL. His total billirubin (TBili) and international normalized ratio (INR) are initially normal, but then later become elevated. The AG-ACNP is concerned he has developed: Question options: Fulminant liver failure Ischemic hepatitis Hepatorenal syndrome Portal vein thrombosis. Need Assignment Help?