How do you explain Mr Willis’ dark urine and dark stools? Would Mr Willis benefit from any medication following admission? Explain your answer. Why is it necessary to repeat his red cell G6PD levels after 2 months?
CASE ANALYSIS:
Mr. Willis, a 46-year-old mechanic, is referred to hospital by his primary care doctor. He gave a history of diarrhea and vomiting a week ago and now was complaining of headaches and feeling ‘lousy’. His doctor had given him metoclopramide and ferrous sulphate. Mr Willis did not appear jaundiced although he said he had noticed his urine was unusually dark a few weeks ago. On examination, he was obese with a blood pressure of 120/80mmHg and had a pulse of 80. Rectal examination revealed black stools. He had a normal gastroscopy with three negative FOBs. His serum biochemistry showed a normal level of alanine transaminase and a slightly raised total bilirubin level. Mr Willis’ reticulocyte count was 13.5% (normal range: 0.5–1.5%). He was diagnosed with having G6PD deficiency, probably triggered by an infection.
- How do you explain Mr Willis’ dark urine and dark stools?
- Would Mr Willis benefit from any medication following admission? Explain your answer.
- Why is it necessary to repeat his red cell G6PD levels after 2 months?
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