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A graduate student has suffered from chronic headaches over a few days and has taken over the counter medications to deal with them. On Friday night she goes out drinking with friends and consumes a few drinks, but does not drink to excess. The next morning she shows up in the emergency room with severe upper right quadrant abdominal pain. Lab tests reveal the following:
Test Patient Normal Range
Bicarb 14 23-30 mmol/L
Na 134 135-145 mEq/L
BUN 9 5-20 mg/dl
Creatinine 1.17 0.7 to 1.5 mg/dl
Glucose 350 70-110 mg/dl
Bilirubin 2.1 0.2 o 1.2 mg/ml
AST 468 4-40 U/L
ALT 100 4-40 U/L
Later that night after admission the patient's creatinine level rises and she begins to develop renal failure.
1. What is your diagnosis for this patient?
2. Why does this toxicity cause the symptoms described and how would you treat this patient?
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