A seventy-year-old man having an end stage liver disease with complaints of increasing gait disturbances over the past several weeks and new-onset diplopia and blurry vision. He also complains of persistent headaches, body aches, and intermittent confusion. He had nausea and vomiting, which had impaired his ability to take his lactulose as prescribed. 1.
Neurology findings A focal cranial nerve deficit and an MRI revealed restricted diffusion 2. Hematology findings White blood cell count and differential within normal limits Mild chronic normocytic anemia Slightly prolonged coagulation times Mild thrombocytopenia 3. Plasma chemistry findings Hyponatremia (125mMol/L [reference range 136-146]) Other plasma electrolytes and liver enzymes are within normal limits Lactate is slightly elevated (43 μMol/L [reference range 9-33]), which had not been present in laboratory…
