18歲女性，aggravated yellowish discoloration of skin, poor appetite and dark urine for 3 days.
2/24 nausea and vomiting--> local hospital
Liver tests showed elevated serum total bilirubin (7.6 mg/dl), AST (183 U/L), ALT (111U/L), and ammonia (216 μM/L).
Prothrombin time was prolonged to 18.8 sec (control 11.2 sec).
Ultrasound revealed early cirrhosis of liver.
給予supportive treatment後total bilirubin下降至 4.8 mg/dl.
3/19 general malaise, dizziness and poor appetite, More profound icterus and dark urine.
3/21 住院
PE:
BT 37.8℃, BP 130/50 mmHg, pulse rate 84/min, and respiration rate 20/min.
Consciousness was clear and orientation was normal.
Markedly icteric sclera and skin were noted.
Chest and heart were unremarkable.
The abdomen was soft and mildly distended. Liver and spleen were impalpable. Mild shifting dullness was noted.
No ecchymosis or petechiae.
Bilateral lower leg edema.
NE showed E4M6V5, no cranial nerve deficits and no lateralizing sign.
No flapping tremor or dystonia, mild cog-wheel rigidity
DTR increased slightly.
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