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- W4381949903 abstract "A 59-year-old man presented with anorexia, nausea, and abdominal pain. He was treated for type 2 diabetes mellitus with metformin. Physical examination showed low BMI below 16.5 kg/m2, tachycardia, rapid respiration, and positive Murphy's sign. Laboratory findings are in Table 1. Urinalysis showed an elevated level of ketones. Serology revealed increased levels of aspartate aminotransaminase, urate, lactate, total ketone bodies, and C-reactive protein. Arterial blood gas analysis demonstrated drops in arterial partial pressure of CO2 and blood bicarbonate with an elevated anion gap. Abdominal ultrasound detected no thickening or sonolucent layer of the gallbladder wall. Computed tomography revealed gastrointestinal wall thickening without ascites, free air, or any tumors (Figure). He denied a prior history of abdominal surgery, and had been a heavy alcohol user consuming 80 g/day of alcohol with imbalanced diets. Table 1Laboratory findings on admission Laboratory items Value Reference Biochemistry Albumin, g/dL 4.5 3.8 - 5.2 Conjugated bilirubin, mg/dL 0.4 < 0.2 Aspartate aminotransaminase, U/L 44 12 - 30 Alanine aminotransferase, U/L 17 10 - 42 γ-Glutamyl transpeptidase, U/L 32 12 -65 Blood urea nitrogen, mg/dL 13 8.0 - 23.0 Creatinine, mg/dL 0.7 0.60 - 1.00 Urate, mg/dL 12.4 < 7.0 C-reactive protein, mg/L 11.2 < 3.0 Glucose, mg/dL 85 70 - 109 Hemoglobin A1c, % 6.2 4.6 - 6.2 Lactate, mmol/L 6.57 0.50 - 2.00 Total ketone bodies, mmol/L 4070 26 - 122 Arterial blood gas pH 7.325 7.350-7.40 PaO2, mmHg 89.2 75.0 - 100 PaCO2, mmHg 29.6 35.0 - 40.0 HCO3-, mmol/L 15.1 20.0 - 26.0 Anion gap, mmol/L 22.6 10.0 - 18.0 Base excess, mmol/L -9.4 -3.0 - 3.0 Urinalysis Ketone bodies 3+ - Open table in a new tab" @default.
- W4381949903 created "2023-06-26" @default.
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- W4381949903 date "2023-10-01" @default.
- W4381949903 modified "2023-10-15" @default.
- W4381949903 title "Thiamine Deficiency Manifesting Acute Right Hypochondrial Pain with Lactic Acidosis" @default.
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- W4381949903 doi "https://doi.org/10.1016/j.amjmed.2023.06.006" @default.
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