31st July 2023

A 78-year-old woman with severe pyelonephritis is found to have a blood pressure of 72/40 mmHg

A 78-year-old woman with severe pyelonephritis is found to have a blood pressure of 72/40 mmHg, which is non-responsive to fluids. A diagnosis of septic shock is made and she is transferred to the intensive care unit for vasopressor support.

Blood results:
Sodium 144 (135 – 145 mmol/L)
Potassium 5.2 (3.5 – 5.0 mmol/L)
Creatinine 450 (55 – 120 umol/L)
Urea 22 (2.0 – 7 mmol/L)
Alanine transferase 1374 (3 – 40 iu/L)
Alkaline phosphatase 950 (30 – 100 iu/L)

Her bloods from last year are retrieved from her GP records, and no abnormalities are seen. To explain the deranged LFTs, a provisional diagnosis of ischaemic hepatitis is made. What is the most likely cause of the deranged U&Es?

Select the SINGLE most appropriate option from the list below. Select ONE option only.