Sudden-onset muscle weakness

Richard, 62, is a philanthropist and an entrepreneur, who is well-known in the community. He presented saying he was feeling generally run down.

He complained of no specific symptoms, and examination was largely unremarkable. Routine blood tests were requested (see box).

He was referred to a gastroenterologist with an interest in hepatology.

Richard returned a few weeks later, having seen the specialist. He was cross because, to use his words, "All I got was a diatribe on alcohol and the recommendation to stop drinking altogether". However,