A patient with long-standing alcoholic cirrhosis presents to your ER with altered mental status…or fever….or abdominal pain… or new onset ascites. He reports this is his normal skin color. He also reports his wife’s hair is always 4 feet tall and blue and his children’s hair color is the exact same color as their skin.
What is the likely diagnosis?
Spontaneous Bacterial Peritonitis
‘
How do you diagnose this?
Diagnostic Paracentesis with PMN >250
What is treatment for this disease?
Antibiotics of course – usually a 3rd generation cephalosporin like ceftriaxone or cefotaxime.
By Dr. Andrew Grock and Dr. Sally Bogoch.
References
Tintinalli’s 7th ed
uptodate.com
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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andygrock
- Resident Editor In Chief of blog.clinicalmonster.com.
- Co-Founder and Co-Director of the ALiEM AIR Executive Board - Check it out here: http://www.aliem.com/aliem-approved-instructional-resources-air-series/
- Resident at Kings County Hospital
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Beyond the “bored review”, there is SOME evidence to support the use of albumin infusion in order to prevent the complication of renal impairment. An interesting but somewhat underpowered study:
Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999 Aug 5;341(6):403-9. PMID: 10432325