4. The coagulation panel is consistent with disseminated intravascular coagulation

It has become increasingly apparent that even mild hypoglycemia can produce adverse consequences in patients and should be treated, especially since the patient’s confusion might well be secondary to hypoglycemia. Administration of 50 grams of glucose raised his blood sugar but did nothing for his confusion.

The abnormal coagulation panel is most consistent with disseminated intravascular coagulation (DIC). An older name for DIC was consumptive coagulopathy which is descriptive of its pathogenesis. DIC occurs when the formation of small blood clots inside the blood vessels throughout the body consumes coagulation proteins and platelets, normal coagulation is disrupted and abnormal bleeding can occur from a variety of sites including the skin (e.g. from venipuncture sites), the gastrointestinal tract, the respiratory tract and surgical wounds. The small clots also disrupt normal blood flow to organs, and multisystem organ failure is often a consequence. This patient’s platelet count is higher than expected but this can occur, especially with chronic DIC, when platelet production is able to match platelet consumption. Haptoglobin is a protein that binds free hemoglobin which can be released from damage done to red blood cells by the intravascular clots. The D-dimer one of the fibrin degradation products and nonspecifically indicates that blood clots are being degraded by fibrinolysis.

In this patient a wheal formed when the skin was stroked. Which of the following is/are true?

  1. Wheal formation from stroking the skin is known as Darier’s sign
  2. Wheal formation from stroking the skin is known as Derriere’s sign
  3. This patient’s skin disease is consistent with urticaria pigmentosa which is associated with wheal formation
  4. 1 and 3
  5. None of the above

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