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Ammonia/Liver/hepatic encephalopathy
by Cherryl, Nov 21, 1999 12:00AM
We are at a total loss and would like some suggestions on where to turn. I want to give background, this will be lengthy.
Our mother is 68, has had a heart attack, several silent ones, colon cancer (which has been removed), congestive heart failure, and gall bladder removed. At one time, we think around 92-93, she had jaundice. She had lost a lot of weight at one point, but don't remember if they ever told us why. Her platelets had been down to 45,000 to 50,000 around June 1998. Because of all her problmes, her liver panel has been elevated for about 4 years.
Late December 98 she had a spell (for lack of better term) where she was acting silly and couldn't function properly. Se went to the hospial that night and stayed for several days. The next spell happened 5 week later. She seemed to want to sleep a lot the day before she had the spells. They appeared to come on at night after going to bed. She messed in her bed and wouldn't get out, was combative and child like, and she looked at us, but it was like she was looking though us. It appeared that when she had to urinate, it would wake her up enough to where she would want to go to the bathroom. She was out of the spell by the next day. For the next 2-2 1/2 months these spells became closer together and more severe. At one point she didn't know us. Her cardiologist was certain it was dimentia (dementia) but sent her to neurologist. She had MRI, MRA, and EEG. All were fine. He said she didn't have dimentia (dementia), but didn't know what was wrong. No doctor saw her during one of these spells. One doctor at an ER said it was dimentia (dementia) and not to bring her in, there was nothing they could do. On 3/18/99 she had a severe spell and that was the last one - until 11/11/99. She had another mild spell and came out of it right away and went out of the house that afternoon. This past Friday (11/19/99) she began to have another one. It was not mild. She had messed in the bed again. This time we had her taken to an ER. The paramedics said her O2 was low and put her on oxygen. Then she began to respond a little. She vomitted in the ER. The ER did a CT of the brain and it was OK. They admitted her. The hospital did bloodwork. As ususal the liver enzymes were elevated. Saturday morning they indicated her ammonia level was at 187 and her platelets were 50,000. They did a CT on the abdoman and the only thing he said he saw was a large kidney stone. She had a kidney infection. They gave her lactulose. This is Sunday and she has not totally come out of this spell. He said he will probably send her home tomorrow and doesn't appear interested (but that is another story). Anyway, we are at a loss. We've read articles on the internet and to us it doesn't appear very good. We are at a loss and don't feel she should be going home (she lives alone). We don't know where to turn for help or answers. We are in Watertown, NY and don't see a hepatologist in the phone book. Do you have any information or suggestions as to what might be going on with her body or a doctor you could recommend - even in Syracuse, NY?
Thank you for your time and assistance.
Cheryl and Terri
Our mother is 68, has had a heart attack, several silent ones, colon cancer (which has been removed), congestive heart failure, and gall bladder removed. At one time, we think around 92-93, she had jaundice. She had lost a lot of weight at one point, but don't remember if they ever told us why. Her platelets had been down to 45,000 to 50,000 around June 1998. Because of all her problmes, her liver panel has been elevated for about 4 years.
Late December 98 she had a spell (for lack of better term) where she was acting silly and couldn't function properly. Se went to the hospial that night and stayed for several days. The next spell happened 5 week later. She seemed to want to sleep a lot the day before she had the spells. They appeared to come on at night after going to bed. She messed in her bed and wouldn't get out, was combative and child like, and she looked at us, but it was like she was looking though us. It appeared that when she had to urinate, it would wake her up enough to where she would want to go to the bathroom. She was out of the spell by the next day. For the next 2-2 1/2 months these spells became closer together and more severe. At one point she didn't know us. Her cardiologist was certain it was dimentia (dementia) but sent her to neurologist. She had MRI, MRA, and EEG. All were fine. He said she didn't have dimentia (dementia), but didn't know what was wrong. No doctor saw her during one of these spells. One doctor at an ER said it was dimentia (dementia) and not to bring her in, there was nothing they could do. On 3/18/99 she had a severe spell and that was the last one - until 11/11/99. She had another mild spell and came out of it right away and went out of the house that afternoon. This past Friday (11/19/99) she began to have another one. It was not mild. She had messed in the bed again. This time we had her taken to an ER. The paramedics said her O2 was low and put her on oxygen. Then she began to respond a little. She vomitted in the ER. The ER did a CT of the brain and it was OK. They admitted her. The hospital did bloodwork. As ususal the liver enzymes were elevated. Saturday morning they indicated her ammonia level was at 187 and her platelets were 50,000. They did a CT on the abdoman and the only thing he said he saw was a large kidney stone. She had a kidney infection. They gave her lactulose. This is Sunday and she has not totally come out of this spell. He said he will probably send her home tomorrow and doesn't appear interested (but that is another story). Anyway, we are at a loss. We've read articles on the internet and to us it doesn't appear very good. We are at a loss and don't feel she should be going home (she lives alone). We don't know where to turn for help or answers. We are in Watertown, NY and don't see a hepatologist in the phone book. Do you have any information or suggestions as to what might be going on with her body or a doctor you could recommend - even in Syracuse, NY?
Thank you for your time and assistance.
Cheryl and Terri
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Good luck