Raised serum lactate in a cirrhotic patient presenting after a trivial fall

Abstract

We present the case of a pelvic fracture in a 69-year-old man with Child–Pugh class C cirrhosis who presented to the Accident and Emergency department after a slip on wet grass. After initially being systemically well, he became haemodynamically unstable in the Emergency department requiring resuscitation via the massive transfusion pathway. He was admitted to intensive care unit for resuscitation following a CT angiogram which showed no arterial bleed, but significant retroperitoneal haematoma. He received a prophylactic embolization of the internal iliac artery 2 days later and his acetabular fracture was managed with skeletal traction. He died 7 weeks later as a result of his liver failure. We propose that a high index of suspicion would have led to an earlier diagnosis of his venous bleed and earlier transfusion.

Factors predicting mortality in patients with alcoholic liver cirrhosis visiting the emergency department

“…A patient with LC visiting the ED after a trivial fall had an elevated lactate level, even though it was difficult to detect bleeding promptly due to slow bleeding caused by pelvic fractures. [39] A rapid change in the lactate level will promote early detection of deterioration. To improve clinical outcomes, serum lactate should be measured immediately upon visiting the hospital.…”