The Clinical Problem Solvers
Episode 304: Spaced Learning Series – The Journey of 3Hs: Hyperbilirubinemia, Hypoxia and Hemolysis
Oct 4, 2023
Guests Anna Fretz, Priyanka Athavale, and Kirtan Patolia discuss a case of a patient with hyperbilirubinemia due to alcoholic hepatitis, who later developed hypoxia and hemolysis. They talk about the evaluation of hyperbilirubinemia, the workup for alcoholic hepatitis, and the basics of methemoglobinemia.
35:34
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Quick takeaways
- Evaluating jaundice requires a schema approach to determine if it is due to indirect or direct hyperbilirubinemia and explore the associated causes.
- Assessing hypoxemia involves evaluating the alveolar-arterial gradient and response to supplemental oxygen to determine the location and potential causes of oxygenation problem.
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Case Overview
This podcast episode discusses the case of a young man presenting with progressively worsening abdominal pain, nausea, vomiting, and anorexia. He has a history of heavy alcohol use and recent stress related to unemployment. On examination, he shows signs of jaundice and tenderness in his right upper quadrant. Laboratory tests reveal elevated liver enzymes, neutrophilic leukocytosis, and direct hyperbilirubinemia. The main focus of the discussion is to evaluate the cause of the patient's jaundice and explore the differential diagnosis for direct hyperbilirubinemia.
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