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Gastroenterology (Expert Forum)
Acetominophen, Hepatic Lab Tests, Bipolar...freaking out
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Acetominophen, Hepatic Lab Tests, Bipolar...freaking out
by Rich W, Sep 29, 2005 12:00AM
OK...long story tried to be made shorter: HX: 46 yo Physician, bipolar on chronic Depakote, Lamictal and Klonopin. S/p Gastric bypass (short limb roux-n-y 11/04). Chronic Back pain syndrome- using Hrydocodone elixer (HCD, ETOH, APAP). Have had multiple episodes (3) where I've exceeded the 4g/APAP a day rule (But never much more). I always take it with food, never fasting.No NSAIDS.
Eat a very high protein diet, have lost about 95 lbs, now nrml weight, cholesterol, no more HTN, no more Type II..yada yada All cardiac risk factors in line, which is great because I have lousy genes.
NOW I'm freaking: ALT 51/AST 22/BUN 19 and Ammonia (done on serum) was 37! sheesh.... My albumin is 5.1, total Billi is 1.9, my glucose is normal, no evidence of coagulopathy, all lytes ok and GGT is 62. Alk phose and amylase normal. Abdominal U/S showed "borderline hepato and splenomegaly" (told it was probably resolving fatty liver). Normal kidneys and GB/ducts etc. No comment on liver parenchyma. No ETOH at all, save for what's in the pain med. No APAP save for what's in the pain med.No recreational drugs, not sexually active. Have cut down the Depekote wondering if it is potentially a hepatoxin.
I've had mild diffuse abdominal pain on and off since surgery, of course the pain med taken for other reasons knocks it off too. But pain is epigastric and R. mid and sorta upper quad......especially if I eat a little too much. In general, I'm quite carefull.
Again, I do eat a VERY high protein diet, ISOPURE shakes, vitamins, etc and very low fat. I don't THINK I'm encephalopathic (I'm kind of irritable/sardonic by nature, and bi-polar, my shrink says I'm ok), and I'm not jaundiced.
OK so....I'm going to find a hepatologist. But being a researcher now, (it's been 10 years since I was seeing patients) just give me some good news.....need I worry? I have three young children and don't care to be shopping for a transplant.
Should I let somone come at me with a needle at this point? Is there such thing as "chronic" APAP toxicity, can I be hiding a significant liver injury and not know it (based on the #'s).
It's amazing feeling so powerless re: how to proceed. I live 90 miles from the nearest referral center. Yes, it's humiliating to have these worries, to be a patient in general, and to ask these questions in this forum.
Thanks!
Eat a very high protein diet, have lost about 95 lbs, now nrml weight, cholesterol, no more HTN, no more Type II..yada yada All cardiac risk factors in line, which is great because I have lousy genes.
NOW I'm freaking: ALT 51/AST 22/BUN 19 and Ammonia (done on serum) was 37! sheesh.... My albumin is 5.1, total Billi is 1.9, my glucose is normal, no evidence of coagulopathy, all lytes ok and GGT is 62. Alk phose and amylase normal. Abdominal U/S showed "borderline hepato and splenomegaly" (told it was probably resolving fatty liver). Normal kidneys and GB/ducts etc. No comment on liver parenchyma. No ETOH at all, save for what's in the pain med. No APAP save for what's in the pain med.No recreational drugs, not sexually active. Have cut down the Depekote wondering if it is potentially a hepatoxin.
I've had mild diffuse abdominal pain on and off since surgery, of course the pain med taken for other reasons knocks it off too. But pain is epigastric and R. mid and sorta upper quad......especially if I eat a little too much. In general, I'm quite carefull.
Again, I do eat a VERY high protein diet, ISOPURE shakes, vitamins, etc and very low fat. I don't THINK I'm encephalopathic (I'm kind of irritable/sardonic by nature, and bi-polar, my shrink says I'm ok), and I'm not jaundiced.
OK so....I'm going to find a hepatologist. But being a researcher now, (it's been 10 years since I was seeing patients) just give me some good news.....need I worry? I have three young children and don't care to be shopping for a transplant.
Should I let somone come at me with a needle at this point? Is there such thing as "chronic" APAP toxicity, can I be hiding a significant liver injury and not know it (based on the #'s).
It's amazing feeling so powerless re: how to proceed. I live 90 miles from the nearest referral center. Yes, it's humiliating to have these worries, to be a patient in general, and to ask these questions in this forum.
Thanks!
Doctor's Answer
by Kevin Pho, MD, Sep 30, 2005 12:00AM
, Sep 30, 2005 12:00AM
Different people will have varying tolerances to chronically high doses of acetominophen. Other co-existing liver diseases can also affect this.
The liver enzymes are mildly elevated - and the liver ultrasound did not suggest cirrhosis. However, as you know, cirrhosis is a pathological diagnosis and only a biopsy would give a definitive answer.
Blood tests looking for hepatitis can be done.
Regarding the biopsy, it may be reasonable to repeat the liver enzymes serially, and if they continue to rise, then proceed with the biopsy.
However, if there is continuing concern about the liver (with the high use of acetominophen), a hepatologist may elect to do the biopsy sooner.
You can also look at diseases other than the liver - including an ulcer, gastritis or duodenitis. An upper endoscopy would be helpful to rule these causes out.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
The liver enzymes are mildly elevated - and the liver ultrasound did not suggest cirrhosis. However, as you know, cirrhosis is a pathological diagnosis and only a biopsy would give a definitive answer.
Blood tests looking for hepatitis can be done.
Regarding the biopsy, it may be reasonable to repeat the liver enzymes serially, and if they continue to rise, then proceed with the biopsy.
However, if there is continuing concern about the liver (with the high use of acetominophen), a hepatologist may elect to do the biopsy sooner.
You can also look at diseases other than the liver - including an ulcer, gastritis or duodenitis. An upper endoscopy would be helpful to rule these causes out.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
Member Comments
by breeze111, Oct 04, 2005 12:00AM
I have Chronic Back pain in my left hip, I eat over 200 tylenol 500 mgs a month and more for over 2 years now and my doctor precribes it to me for my arthritis, the robaxin I took for a long time and saprin caused burns in my stomach, he also gives me darvons to use in between the tylenol, I can not take anything with asprin content for the robaxin took care of that and all the nasids I was on for the condition, I recived a call from the doctor yesterday after my cat scan(I made him give me due to my mothers condition and he said the cat scan showed lungs were ok but the liver showed cysts, I told him I eat the tylenol and he knows it for he started me on it so I would not get addicted to other drugs.. he has this thing about addictions and yet he prescribes me 200 tylenol a month and darvons.. should I be concerned about the liver and all that tylenol for I have taken every thing just about when it comes to arthritis , baxtra viox you name it.. and the nagging pain just stays there and gets worse when it rains .. I am 48 and the pain.. I ask my doctor all the time what can I take for the tylenol will someday kill me and he just changes the subject.. I have taken the patches and tans unit all of it and back doctors but always go back to eating the tylenol so I have to go to him next week about the liver and what the ct scan showed in it. what med can I take for the pain ?? that is not addicting and does not contain asprin etc.. I would love to know that one for he has still failed to tell me it also.. thanks
