steroids – diuretics – bili and discharge

His parents are upset that he needs another test, but pleased it won’t stop them going home or its only one test. They will be back for clinic next week.

The ultrasound has shown a clot in the right femoral vein and Dominic is now on daily subcutaneous heparin, which makes him cry.

The result comes back the following day. Because the baby has now left, it is not picked up until the clinic visit the next week.

Bilirubin                                              256 micormol/L

At clinic the following week he is notably more jaundiced. His stools are pale and urine now dark. His parents are very worried there is a serious problem.

He is readmitted and some further tests are done:

Hb       112 g/L

Wcc    6.3 x 10⁹/L

Plats    313 x 10⁹/L

Bilirubin                                              276 micormol/L (228 conjugated)

Alkaline phosphatase             365 U/L

Alanine aminotransferase                  112 U/L

TSH                                                    2.1 mU/L

DCT                negative

Urine MSU     negative

He is discussed with the hepatology service. They accept him for transfer, but because of the MRSAs that have been identified, will not be able to take him for two days until a cubicle is available. Dominic’s parents ask whether this could have been avoided earlier.

Further investigations show that he has biliary atresia. He undergoes surgery for this, which is successful. Following this his stools become darker again and he makes good progress.