Question: A 59-year-old woman presented to the emergency department with nausea and epigastric pain for 2 days preceded by 2 weeks of anorexia. Several years ago, she was diagnosed as glucose intolerant, but did not receive regular follow-up. On examination, her temperature was 34.8°C and her blood pressure was 81/53 mm Hg. She had icteric sclera, palpated tenderness in the upper right quadrant of the abdomen, and hepatomegaly (liver span of 14 cm at the midclavicular line). Blood tests showed a leukocyte count of 5700/mm3, (55% neutrophils; 19% lymphocytes), a glucose level of 347 mg/100 mL, an aspartate aminotransferase of 10,920 U/L, an alanine aminotransferase level of 3651 U/L, a total bilirubin of 4.8 mg/dL, and a creatinine level of 3.4 mg/100 mL. Plain film of the chest was normal...

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