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Abnormal CMP

31 year old female presents  at pain clinic for complaints of neck and low back pain, history of ORIF ankle after MVA. She has been on Oxycodone IR without Tylenol and MS Contin from another clinic for greater than a year without any lab evaluation.  Admits to 15 year history of heavy alcohol use but none for 6 months. Rest of history is unremarkable. She does not complain of abdominal pain and no jaundice noted.
She takes 10 Goody Powders daily for headache, and joint pain, and has for years.  Last saw a MD with the delivery of child 3 years ago.
CMP abnormal-AST 90  (12-45), Bilirubin- normal, alkaline phosphatase 620 (25-124), ALT 78 (7-51), Protein 7.1  (6.1-8.6) , albumin 2.9  (3.5-5.0), calcium 8.3 (8.8-11), Ion Balance 2 ( 7-16), creatinine <0.0 (0.5-1.31).
Advised her to stop the Goody Powders and referred her to establish a primary care provider to coordinate the  work up.
I scheduled her a PCP appt and told her she would need further laboratory studies and will probably need to see GI also.
Curious as to how the MD's would work this patient up?
Thank you.
1 Responses
Avatar universal
Not familiar with Goody Powders but stopping that seems wise until additional medical attention is obtained.

She has a cholestatic enzyme profile so following a differential diagnosis for "cholestatis without jaundice" is in order and pretty straight forward. Just using the data you've provided here indicates the possibility of advance liver disease and the possibility of cirrhosis - but obviously this is just a guess and just utilizing a wee bit of blood serum data is never a good idea.

Her ast/alt ratio tends to lean towards cirrhosis given that the levels are only mildly elevated (nothing acute seems indicated). Her A/G ratio also supports this being below 1 at 0.7. And, if she isn't suffering from malnutrition, the low albumin level would also indicate a struggling synthesis functioning of her liver.  

Running so long on pain killers without a doctor's monitoring is never a good idea. That, combined with the alcohol, created extended, chronic insults to the liver which must have caused some damage at the very least.

Yes, you should definitely get her to a doctor for evaluation. A GI would probably be a good start and then see where it goes.
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