Determining the Cause
Clinical Presentation
a. History: Woman at 35 weeks gestation
Differential Diagnosis
Acute fatty liver of pregnancy (AFLP)
Next Pivotal Assessment | Finding |
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Physical Exam |
On examination she is found to have elevated blood pressure, proteinuria, increased liver function tests, prolonged clotting studies, hyperbilirubinemia, hypofibrinogenemia, and hypoglycemia. Pelvic ultrasonography identified a viable intrauterine pregnancy of approximately 35 weeks gestation. After admission, the mother underwent emergent cesarean delivery, and she subsequently developed worsening hypoglycemia and coagulopathy and went into hepatic coma with renal failure. After reviewing all the laboratory results and her clinical picture, the patient was diagnosed with acute fatty liver of pregnancy (AFLP).
Reference
https://www.sciencedirect.com/topics/medicine-and-dentistry/long-chain-3-hydroxyacyl-coenzyme-a-dehydrogenase#:~:text=All%20disorders%20in%20this%20group,of%20pregnancy%20or%20hemolysis%2C%20elevated
Bone pain, fatigue, or constipation.
[They will also ask about any medications the patient is taking, as certain drugs can cause hypercalcemia.
After obtaining a medical history, the physician will perform a physical examination to check for signs of hypercalcemia, such as bone tenderness, muscle weakness, or abnormal heart rhythm.
Laboratory tests will then be conducted to confirm the diagnosis of hypercalcemia and to identify the underlying cause. These tests may include:
Serum calcium levels: The physician will check the patient's blood calcium levels to confirm hypercalcemia.
Parathyroid hormone (PTH) levels: PTH is a hormone that regulates calcium levels in the body. High PTH levels can indicate primary hyperparathyroidism, while low PTH levels can indicate malignancy.
25-hydroxyvitamin D levels: This test measures the level of vitamin D in the blood, which is important for calcium absorption. Low levels of vitamin D can cause secondary hyperparathyroidism.
Urine calcium levels: This test measures the amount of calcium excreted in the urine. High levels of urine calcium can indicate hyperparathyroidism or other causes of hypercalcemia.
Imaging tests: X-rays, CT scans, or MRI scans may be used to check for bone abnormalities or tumors that could be causing hypercalcemia.
Biopsy: If a tumor is suspected as the cause of hypercalcemia, a biopsy may be performed to confirm the diagnosis.
The treatment of hypercalcemia depends on the underlying cause. Once the cause is identified, the physician will work with the patient to develop an appropriate treatment plan, which may include medication, surgery, or lifestyle changes.]
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