A 72yo woman who had a repair of strangulated femoral hernia 2 days ago becomes noisy,
aggressive and confused. She is febrile, CBC normal apart from raised MCV. What is the most
likely dx?
a. Electrolyte imbalance
b. Delirium tremens
c. Wernicke’s encephalopathy
d. Infection toxicity
e. Hypoglycemia
answer: B
Causes of Macrocytic Anemia
ABCDEF
Alcoholism (liver disease)
B12 deficiency
Compensatory reticulocytosis
Drugs (cytotoxic, AZT)/Dysplasia
Endocrine (hypothyroidism)
Folate deficiency/Fetus (pregnancy)
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