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Gastroenterology (Expert Forum)
drug induced hepatitis
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.
drug induced hepatitis
by virginiaguy, Dec 18, 2005 12:00AM
Hello:
I'm a 33 year old male with a previously clean bill of health. I eat right, don't smoke. Drank moderately (1 drink per day max). Wasn't on any meds until this fall.
I was diagnosed with drug-induced hepatitis in early Oct. of this year after taking bactrum for 13 days and taking about 6 advil per day--I was taking the medication b/c I was diagnosed with a prostrate infection (stds ruled out by testing). I went to the ER and the hepatitis panel came back neg. for A, B, C. I stopped taking the meds and stopped alch. and any other meds. it took me about a week and a half for my numbers to begin to decline and it took me about 3 weeks to feel up to returning to work and normal life. At its worst my bilirubin was at about 12 and my ALT was just under 1000 and my AST was at about 550 or so. My alk phosphate was in the mid 200's. anti-nuclear antibody was 1.80. The numbers declined in late oct and early nov. I had all the symptoms of hepatitis. I was very ill and was on bedrest for 2 weeks. Went to the doc. and liver doc. regularly all through oct. I drank fluids and ate as much as I could but lost about 10 pounds and was very weak at the end of Oct.
I got regular bloodwork until the first week of Nov. and the numbers were: alk phost--263, alt--172, ast--80, and bili was 3.2 (dir and indirect were 1.6). And then was told by my doctor to come back in several weeks for a follow up. I returned to my high stress job and gained strength and gained the weight back. I began some light exercise--jogging, a bit of tennis, walking, etc. I began taking low amounts of vitamin c and saw palmetto for prostate health about three weeks ago.
Last week (12/12) I went in for blood work and my bilirubin was fine, but my other numbers had gone up (which shocked me)--as of dec 12th the numbers were: alk phos. 323, alt 231, ast 104. I do not feel very sick right now--much better. My other symptoms seem mild at this point--some slight inflamation (inflammation) in my liver perhaps (can't tell if it is my imagination or not), some slight night sweats and difficulty sleeping, some fatigue, and maybe frequent urination (difficult to tell b/c I drink a lot of water).
I'm going back to my liver doctor for an evaluation this week but need a second opinion.
Questions:
1. To what extent do you think my liver might be permanently damaged? In other words, what are the chances in this case?
2. Estimated recovery period? How much does stress hurt
3. I am eating fine--no nausea, etc. And I generally feel ok: should I still be worried about these numbers?
4. To what extent do you think taking saw palmetto may have contributed to the increased numbers in the past month or so?
5. Do you think I can continue exercising with these numbers? Will that help or hurt my liver? Doe
6. What are the chances the diagnosis of drug-induced hepatitis is wrong? Any chance the drug-induced spured on an auto-immune hepatitis?
Thank you for your help.
I'm a 33 year old male with a previously clean bill of health. I eat right, don't smoke. Drank moderately (1 drink per day max). Wasn't on any meds until this fall.
I was diagnosed with drug-induced hepatitis in early Oct. of this year after taking bactrum for 13 days and taking about 6 advil per day--I was taking the medication b/c I was diagnosed with a prostrate infection (stds ruled out by testing). I went to the ER and the hepatitis panel came back neg. for A, B, C. I stopped taking the meds and stopped alch. and any other meds. it took me about a week and a half for my numbers to begin to decline and it took me about 3 weeks to feel up to returning to work and normal life. At its worst my bilirubin was at about 12 and my ALT was just under 1000 and my AST was at about 550 or so. My alk phosphate was in the mid 200's. anti-nuclear antibody was 1.80. The numbers declined in late oct and early nov. I had all the symptoms of hepatitis. I was very ill and was on bedrest for 2 weeks. Went to the doc. and liver doc. regularly all through oct. I drank fluids and ate as much as I could but lost about 10 pounds and was very weak at the end of Oct.
I got regular bloodwork until the first week of Nov. and the numbers were: alk phost--263, alt--172, ast--80, and bili was 3.2 (dir and indirect were 1.6). And then was told by my doctor to come back in several weeks for a follow up. I returned to my high stress job and gained strength and gained the weight back. I began some light exercise--jogging, a bit of tennis, walking, etc. I began taking low amounts of vitamin c and saw palmetto for prostate health about three weeks ago.
Last week (12/12) I went in for blood work and my bilirubin was fine, but my other numbers had gone up (which shocked me)--as of dec 12th the numbers were: alk phos. 323, alt 231, ast 104. I do not feel very sick right now--much better. My other symptoms seem mild at this point--some slight inflamation (inflammation) in my liver perhaps (can't tell if it is my imagination or not), some slight night sweats and difficulty sleeping, some fatigue, and maybe frequent urination (difficult to tell b/c I drink a lot of water).
I'm going back to my liver doctor for an evaluation this week but need a second opinion.
Questions:
1. To what extent do you think my liver might be permanently damaged? In other words, what are the chances in this case?
2. Estimated recovery period? How much does stress hurt
3. I am eating fine--no nausea, etc. And I generally feel ok: should I still be worried about these numbers?
4. To what extent do you think taking saw palmetto may have contributed to the increased numbers in the past month or so?
5. Do you think I can continue exercising with these numbers? Will that help or hurt my liver? Doe
6. What are the chances the diagnosis of drug-induced hepatitis is wrong? Any chance the drug-induced spured on an auto-immune hepatitis?
Thank you for your help.
Doctor's Answer
by Kevin Pho, MD, Dec 19, 2005 12:00AM
, Dec 19, 2005 12:00AM
To answer your questions:
1) I cannot give a prediction as to permanent damage. However, with the ALT being peristantly elevated to such a level, I would consider a liver biopsy to pin down the diagnosis. Once there is a diagnosis, the question of permanent damage can be answered.
2) Recovery period would depend on what exactly is causing the liver enzyme elevation.
3) With the persistantly elevated numbers, I would consider a liver biopsy.
4) It may be possible that saw palmetto may be contributing to the enzyme elevation.
5) I am not aware of exercise being associated with the liver enzyme elevation.
6) Other causes of hepatitis should be considered, including autoimmune hepatitis. The liver biopsy would shed more light on this.
You can discuss these options with your personal physician.
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.
kevinmd_b
1) I cannot give a prediction as to permanent damage. However, with the ALT being peristantly elevated to such a level, I would consider a liver biopsy to pin down the diagnosis. Once there is a diagnosis, the question of permanent damage can be answered.
2) Recovery period would depend on what exactly is causing the liver enzyme elevation.
3) With the persistantly elevated numbers, I would consider a liver biopsy.
4) It may be possible that saw palmetto may be contributing to the enzyme elevation.
5) I am not aware of exercise being associated with the liver enzyme elevation.
6) Other causes of hepatitis should be considered, including autoimmune hepatitis. The liver biopsy would shed more light on this.
You can discuss these options with your personal physician.
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.
kevinmd_b
