title: Acute fatty liver of pregnancy with hypoglycaemia, diabetes insipidus and pancreatitis, preceded by intrahepatic cholestasis of pregnancy.
abstract: We present the case of a 33-year-old woman in her first pregnancy. She presented with pruritus at 34 weeks gestation. A diagnosis of intrahepatic cholestasis of pregnancy was made based on elevated bile acids and elevated liver transaminases. She re-presented 4 days later, jaundiced with abdominal pain and nausea, and was hypertensive. Her bilirubin was now elevated and her creatinine had doubled. The differential diagnosis-included pre-eclampsia and Hemolysis Elevated Liver enzymes Low Platelet count (HELLP) syndrome, and delivery was expedited. Postnatally, the patient became coagulopathic, though not thrombocytopaenic; she had persistent hypoglycaemia, hyponatraemia, developed acute pancreatitis and had profound ascites and peripheral oedema. Management was supportive with multidisciplinary care and over a period of 3 weeks she made a full clinical and biochemical recovery.
authors: Department of Obstetrics & Gynaecology, King Edwards Memorial Hospital, Subiaco, Western Australia, Australia Department of Obstetrics & Gynaecology, Joondalup Health Campus, Joondalup, Western Australia, Australia.
authors: Nicola
authors: N
authors: English
authors: Department of Obstetrics & Gynaecology, Joondalup Health Campus, Joondalup, Western Australia, Australia Faculty of Medicine, University of New South Wales, UNSW Sydney, New South Wales, Australia.
authors: Jegajeeva
authors: J
authors: Rao
mesh_terms: D000328:Adult; D002780:Cholestasis, Intrahepatic / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D003919:Diabetes Insipidus / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005865:Gestational Age; D017359:HELLP Syndrome / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis*; D010195:Pancreatitis / Q000175:diagnosis*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology