Question

Q1. A 32 years old Omani man was admitted to hospital with symptoms of malaria and hepatic damages. Medical advisor advised him antimalarial drug primaquine. After administration of primaquine this patient was facing sever hemolysis and rise of the bilirubin in serum level.

a. Identify the disease of the patient from the above statement.

b. Explain the possible reasons for increase in serum bilirubin level. What are the enzyme parameter needed to be checked for hepatic damages.

c. State the possible reason after some days this patient is diagnosed with type 2 diabetes.

Answer 1

a. Jaundice with hepactic dysfunction

b.Serum alanine amino transferase (ALT) level was above the reference range in 67.6%, but in only 11.4%, ALT was more than 3 times of normal level. Serum bilirubin was found to be higher than normal level in 81%, however, only in 23% of the patients, Serum bilirubin was >3mg/dl. Predominantly conjugated hyperbilirubinemia was observed in patients with high ALT. There was no significant change in serum albumin and prothrombin time. In comparison to normal bilirubin level, the patient with bilirubin >3mg/dl had high frequency of raised ALT 87.5% vs. 45% (p<.0001), thrombocytopenia 91.6% vs. 65% (p<.01), anemia 70.8% vs. 25% (p<.05) and renal impairment 50% vs. 20% (p>.05). Overall, 5 (4.7%) patients died and mortality rate was high among the patients with bilirubin level>3mg/dl than with normal bilirubin level 4 (16.6%) vs 1 (5%).

Hepatic dysfunction in acute P.falciparum malaria ranged from mild elevation of liver enzymes to acute hepatitis (ALT>10 times of normal level). It indicates severe illness with high frequency of complication and mortality rates .

c.As with sugar, any amount of ketones detected in your urine could be a sign ofdiabetes and requires follow-up testing.Bilirubin. Bilirubin is a product of red blood cell breakdown. ... Bilirubin in your urine may indicate liver damage or disease.