steroids – diuretics – split bili and other tests

His parents are upset that they are not able to take him home and not keen for him to have further test. However they are also keen for any problems to be identified before he leaves.

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

The blood tests are done and all available the following morning. During this time it becomes clear that Dominic’s stools are paler than normal.

Hb       112 g/L

Wcc    6.3 x 10⁹/L

Plats    313 x 10⁹/L

Bilirubin                                              256 micormol/L (198 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.