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28 y/o f with acetaminophen toxicity,Type 1 dm and major depressive disorder develops hepatic encephalopathy and hepatic failure on 6th day of hosp, she is comatose. CT scan brain shows diffuse swelling.Liver transplantation is contemplated.Which is true
A.DM 1 is a contraindication
B.Do not transplant as liver function will return to normal
C.proceed with transplant
D.depression is a contraind
E.the increased levels of acetaminophen will damage the new liver as well
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E and D are not answer.
E...acetaminophen should be metabolised by live to toxic metabolite but already failed
D...depression is not CI.
And I don't think A is right too.
The answer lies b/n B and C.
I picked B. This was the way I dealt with it.What do you think?
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why not e?
acetaminophen level in blood is still in toxic range, it may damage new liver too. b cant be answer as patient will die without new liver.
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This pt should be treated supportively.New liver doesn't do anything about the brain edema neither the toxin .
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kaplan says you transplant patient if severe hepatic problem in acetaaminophen poisoning
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C. NBME Qs are unique and no one knows the correct answer. I think you should go ahead with the transplanting.
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C
I don't think people who didn't take NBME need to stay away from it.. 'cuz there's no officially right answer..
