NU684 Unit 5 Acute Fatty Liver Case Analysis Example

Course	NU684 Obstetrical Care
Unit	Unit 5
Paper type	Complication case analysis
Length	About 1,100 words, 6 pages double-spaced
Format	APA 7 student paper
School	Purdue University Global
Program	MSN
Updated	October 2026

Free sample paper for NU684 Unit 5

A Glucose of 52 at Thirty-Five Weeks: A Unit 5 Case Analysis Separating Acute Fatty Liver of Pregnancy From HELLP Syndrome

[Student Name]

Purdue University Global

NU684: Obstetrical Care

Unit 5 Complication Case Analysis

[Instructor Name]

[Date]

The patient and laboratory values are composite and illustrative; the sources cited are real.

What this part is doingNaming the two laboratory clues in the lead tells the reader the analysis will turn on specific findings rather than a general impression.

The Presentation

Ms. Carrow is 26, gravida 1, at 35 weeks 1 day, with an uncomplicated pregnancy until last week. She reports a week of nausea and vomiting, loss of appetite, malaise, pain in the upper abdomen and unusual thirst. She has not had headaches or visual changes. Her prepregnancy body mass index was 19.

On arrival her blood pressure is 138/88, pulse 108 and temperature 37.4 degrees Celsius. She looks unwell and mildly jaundiced. Her abdomen is soft with tenderness in the upper right and middle. Fetal heart rate tracing shows minimal variability without decelerations.

Her laboratory results are: aspartate aminotransferase 290 U/L, alanine aminotransferase 340 U/L, total bilirubin 5.8 mg/dL, glucose 52 mg/dL, creatinine 1.6 mg/dL, uric acid 9.1 mg/dL, white cell count 18,000 per microliter, platelets 110,000 per microliter, hemoglobin 12.4 g/dL, international normalized ratio 1.8 and fibrinogen 140 mg/dL. Urine protein is trace. Ammonia is elevated.

The Differential

Several conditions cause liver dysfunction late in pregnancy, and they differ in urgency and treatment.

HELLP syndrome, hemolysis, elevated liver enzymes and low platelets, is part of the spectrum of preeclampsia. ACOG describes it as a severe form of the disease, usually with hypertension and sometimes with abdominal pain as the main complaint (American College of Obstetricians and Gynecologists [ACOG], 2020). It fits her pain, enzymes and platelets.

Acute fatty liver of pregnancy is a rarer condition in which fat accumulates in liver cells, causing liver failure. In a national cohort study, its incidence was about 5 per 100,000 births; 18 percent of affected women had twins and 20 percent had a body mass index below 20 (Knight et al., 2008).

Viral hepatitis usually produces much higher transaminases and is tested for. Intrahepatic cholestasis of pregnancy causes itching and raised bile acids, not liver failure. Biliary disease causes pain and may raise bilirubin, but not hypoglycemia or coagulopathy.

Telling the Two Leading Diagnoses Apart

HELLP syndrome and acute fatty liver overlap, and some patients have features of both. Several of Ms. Carrow's findings point toward acute fatty liver. Her glucose of 52 reflects failure of the liver's ability to make glucose, uncommon in HELLP. Her international normalized ratio of 1.8 and low fibrinogen reflect reduced production of clotting factors, which is out of proportion to her modest platelet count. Her bilirubin of 5.8 is higher than typical in HELLP. Her kidney injury, raised uric acid, high white count, elevated ammonia and polydipsia also fit. Her blood pressure is only mildly raised, and her hemoglobin is normal, without the hemolysis that defines HELLP.

Low glucose and poor clotting are signs of a liver that has stopped working, not only one that is inflamed.

The Swansea criteria, a set of fourteen clinical and laboratory features, are commonly used to support the diagnosis when six or more are present without another explanation. In the national cohort study, these criteria agreed with clinicians' diagnosis in 97 percent of cases (Knight et al., 2008). Ms. Carrow meets at least nine. Biopsy of the liver is seldom required, according to the gastroenterology society's pregnancy guideline, since it is risky with coagulopathy and the diagnosis is usually clinical (Tran et al., 2016).

What this part is doingListing which of her own findings separate the two conditions shows the diagnosis rests on evidence from her chart rather than on a pattern recalled from a textbook.

Why This Is an Emergency

Both conditions are treated by delivery, but acute fatty liver threatens the mother through hypoglycemia, bleeding, kidney failure, encephalopathy and pancreatitis, and the fetus through maternal metabolic failure. In the national cohort, 60 percent of women needed intensive care, one woman needed a liver transplant and one died, and the perinatal mortality rate was 104 per 1,000 births (Knight et al., 2008). The minimal variability on her fetal tracing is a warning sign.

Stabilization and Delivery

Maternal-fetal medicine, anesthesia, intensive care, neonatology and hepatology are called at once.

Glucose. A dextrose infusion is started, with glucose checked every hour, because hypoglycemia can be profound and recurs until the liver recovers.

Coagulation. Fresh frozen plasma and cryoprecipitate are given to correct the international normalized ratio and fibrinogen before delivery, and platelets are given if needed for surgery. Blood products are prepared for postpartum hemorrhage, which is more likely with coagulopathy.

Delivery. Delivery is the definitive treatment and is not delayed for further testing. Given her unfavorable cervix, the fetal tracing and the need for speed, a cesarean is planned once coagulation is corrected enough for surgery. The anesthesia team decides between general and neuraxial anesthesia based on her clotting values at the time.

Monitoring. Fluid balance, kidney function, ammonia, mental status and glucose are followed closely. Magnesium sulfate is given if preeclampsia cannot be excluded, with dosing adjusted for her kidney function.

After Delivery

Liver function often worsens for a day or two after delivery before improving, and recovery may take a week or more. She remains in intensive care until her glucose, clotting and kidney function are stable. Complications to watch for include hemorrhage, pancreatitis, diabetes insipidus and infection. Transfer to a liver transplant center is considered if she develops worsening encephalopathy or coagulopathy despite treatment.

The Baby

Some cases of acute fatty liver are linked to a fetal deficiency of an enzyme in fatty acid oxidation, long-chain 3-hydroxyacyl-CoA dehydrogenase, which the baby can inherit. The same gastroenterology guideline recommends that infants of mothers with acute fatty liver be tested (Tran et al., 2016). The neonatal team is informed so the baby's glucose is monitored and testing is arranged.

What this part is doingIncluding newborn testing shows the analysis follows the condition's implications beyond the mother.

Counseling and Follow-Up

Once she has recovered, Ms. Carrow and her partner will be told what happened, why delivery was urgent and what the baby's test results mean for future pregnancies. If the baby has the enzyme deficiency, the risk of recurrence is higher, and future pregnancies would be managed with early monitoring. Follow-up includes liver tests until normal, a postpartum depression screen, given the traumatic delivery, and a visit with maternal-fetal medicine before any future pregnancy.

Conclusion

Ms. Carrow's liver dysfunction at 35 weeks could have been labeled HELLP syndrome, but her hypoglycemia, coagulopathy, high bilirubin and kidney injury pointed to acute fatty liver of pregnancy. The distinction mattered because it shaped stabilization before delivery, the postpartum watch for liver failure and testing of her baby. Delivery after correction of glucose and clotting, with a multidisciplinary team, is the treatment for both conditions and the core of her plan.

References

American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia: ACOG practice bulletin, number 222. Obstetrics & Gynecology, 135(6), e237-e260. https://doi.org/10.1097/AOG.0000000000003891

Knight, M., Nelson-Piercy, C., Kurinczuk, J. J., Spark, P., & Brocklehurst, P. (2008). A prospective national study of acute fatty liver of pregnancy in the UK. Gut, 57(7), 951-956. https://doi.org/10.1136/gut.2008.148676

Tran, T. T., Ahn, J., & Reau, N. S. (2016). ACG clinical guideline: Liver disease and pregnancy. American Journal of Gastroenterology, 111(2), 176-194. https://doi.org/10.1038/ajg.2015.430

The Purdue Global NU684 Unit 5 instructions

Unit 5 typically presents a serious complication of late pregnancy, often a liver or kidney disorder, and asks for a case analysis that distinguishes it from conditions that look similar. Prompts generally want the presentation with laboratory values, a differential diagnosis, the features that separate the leading possibilities, the urgency and management, including delivery planning, and follow-up for mother and baby. Instructors reward analyses that connect each laboratory finding to its meaning rather than listing abnormal results. When diagnostic criteria exist, such as the Swansea criteria, applying them to the patient is expected. Multidisciplinary coordination should be explicit. Expected sources include a cohort study or review of the condition, a gastroenterology or hepatology guideline, and the ACOG bulletin on the look-alike condition. Counseling about recurrence and future pregnancies is often required.

How this NU684 Unit 5 example is built

The Carrow analysis presents her symptoms, examination and a full set of laboratory values before naming any diagnosis. The differential describes HELLP syndrome with ACOG's bulletin, acute fatty liver with Knight and colleagues' incidence and risk factors, then hepatitis, cholestasis and biliary disease. A section on telling the two leading conditions apart walks through her glucose, clotting, bilirubin and kidney results, under a highlighted line on a liver that has stopped working, and a margin note marks the use of her own findings. The Swansea criteria and the gastroenterology guideline's view on biopsy follow. The emergency section uses the cohort's outcome figures. Stabilization covers glucose, blood products, delivery and monitoring. Sections on the postpartum course and on newborn testing, flagged by a second note, precede counseling about recurrence and follow-up.

Where the points sit in the NU684 Unit 5 rubric

Complication analyses in NU684 earn marks for diagnostic reasoning, interpretation of laboratory results, urgency and stabilization, delivery planning, multidisciplinary coordination and follow-up. Reasoning credit depends on explaining why one diagnosis is more likely than its look-alike, using the patient's own values. Interpretation is scored on linking each result to the underlying problem, such as hypoglycemia to impaired liver glucose production. Urgency must be clear: graders expect correction of glucose and coagulopathy before surgery and delivery without delay for further tests. Delivery planning includes route and anesthesia considerations. Naming the teams involved, from intensive care to neonatology, is expected. Follow-up should cover postpartum deterioration, newborn testing and counseling about future pregnancies. Tidy headings plus properly cited copies of Knight's cohort, the liver guideline and the preeclampsia bulletin finish the marks.

Common NU684 Unit 5 mistakes, and how to avoid them

Analyses lose marks most often by labeling the patient with HELLP syndrome and moving on, missing the hypoglycemia and coagulopathy that change preparation for delivery. Another frequent gap is delaying delivery for imaging or biopsy, which the guidance does not support. Some papers list abnormal laboratory values without saying what each means. Others forget that liver function can worsen after delivery or that the baby may need testing for a metabolic disorder. Coagulation correction before cesarean is sometimes omitted, a serious safety gap. Begin by sorting the laboratory results into those that fit each diagnosis, then decide which results would change the plan before delivery. After that, list who needs to be called and in what order. Laboratory values and your prompt are all a custom AFLP or HELLP analysis needs to begin.

Get an NU684 Unit 5 example written to your instructions

Send the case, the laboratory values and the analysis instructions with the rubric. A custom analysis separates the possible diagnoses, explains the urgency and plans delivery and recovery. The first one is free, delivered within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.

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NU684 Unit 5 questions, answered

How is acute fatty liver of pregnancy told apart from HELLP syndrome?

The two overlap, but low glucose, very high bilirubin, clotting abnormalities and kidney injury point toward acute fatty liver. Both usually require prompt delivery. An analysis should explain the distinguishing features.

Does the baby need testing after acute fatty liver of pregnancy?

Often, yes. Some cases are linked to a fatty acid oxidation disorder in the baby, so newborn testing is recommended.

Is delivery the only treatment?

Delivery is the definitive treatment, with intensive supportive care for the mother. Recovery usually takes days to weeks.

Where can I find a free NU684 Unit 5 sample paper?

The full NU684 Unit 5 complication case analysis is on this page. It separates acute fatty liver of pregnancy from HELLP syndrome in a composite patient at 35 weeks and plans stabilization, delivery, postpartum monitoring and newborn testing.

Why was the NU684 Unit 5 patient's low glucose important?

Severe hypoglycemia reflects the liver's failure to produce glucose, which is common in acute fatty liver of pregnancy but unusual in HELLP syndrome. It also needs immediate treatment with dextrose and close monitoring until the liver recovers.