Resident:  Our first new patient is Mr. Johnson, a 57-year-old divorced, unemployed white male who was admitted Friday night with a massive upper GI bleed from esophageal varices. He was initially treated with fluids and blood. GI was called – he was scoped and they were able to clip the varix. He required 8 units of blood and saline and pressors; but has been stable since, except for some minor withdrawal that responded to lorazepam.

I was up all night trying to save this guy.  He was transferred to the ward on Sunday. He has a history of chronic hep C and heavy drinking. He’s been through rehab twice, the last time 2 years ago. He reports drinking a 12-pack a day. He has no prior history of a GI bleed. In addition to his cirrhosis, he has type 2 diabetes, hypertension, hyperlipidemia, and mild COPD. And he still smokes a pack a day.

Attending:  How do his numbers look?

Resident:  blood pressure – 130/85; hematocrit – 35; glucose – 138; AST – 50; ALT – 45; total bili – 1.8; albumin – 2.5; INR – 1.6. Other chemistries look good. I don’t think he’s in liver failure.

Attending:  OK – let’s go see him.

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