A 67yr old not known to have any chronic illnesses, occasional alcoholic has been in his usual state of health until this afternoon when he was noticed to be weak and unable to speak. No seizure, no loc. He was rushed here for mgt. On arrival, he was speaking. He has also been having bipedal swelling for abt 6yrs for which he has been receiving treatment at facilities in Cape Coast Vitals on arrival - BP - 113/74, RBS - 7.2, pr - 103 On examination: An elderly male, not in any pain nor distress, p++, j++, pitting bipedal oedema, lower lip deviated to the left Abd: NAD Hb-7.7 Plt - 21 HbsAg - pos Rft - potassium - 5.3, CR - 201.5, urea - 12.9 LFT - AST - 123.3 GGT - 78.8 Alb - 17.9 Total bilirubin - 132.1; direct - 82.7; indirect - 49.4