Liver Mystery

[funkyblond]

I'm going to make a long story short and looking for simple ideas/possible diseases. My wife has been fighting the following symptoms for six months: dizziness, shortness of breath, anxiety attacks, abdominal pain, weight loss (40 lbs in 3 months), fatigue, etc.
We are at Mayo in Rochester, MN tonight and docs are concentrating on the liver due to increased numbers as high as 900 ALT and 400+ AST. High liver levels at this point increased after she was prescribed Reglan (sp.) and the attacks worsened and blood pressure increased to 200/100 until given Ativan. Currently, our doctor mentioned a rare liver disease may be possible, but I honestly couldn't remember the name of it. Has anyone else had a side effect from Reglan, followed by this dramatic increase of liver enzyme count? The Reglan was prescribed 3 weeks ago and she was given four pills equivalent by a doctor after we went to the emergency room complaining of similar symptoms (of course, this was an out-of-town hospital and shouldn't have given that much, but the bottle said "up to 4x per day."
So, any ideas? Or do I need more description? Thank you so much.


This discussion is related to Elevated liver enzymes - should I be concerned with these numbers?.

[bororo]

Thanks boron, i will check out the site.I was placed on motilium like 3months ago.Although i  have stopped using it now(Doc says so).However for the 3 months that i was on it, my period ceased.I have stopped now and i am hoping i resume my normal monthly circle

[boron]

It's drugs.com

[boron]

The substance in Motilium is domperidone, and in Reglan is metoclopramide. They are both anti-emetics.

You can find brand name of almost any drug in deugs.com under "advanced" link. Wikipedia article about domperidone seems interested.

[bororo]

jHi boron,just a quick one, is motilium and reglan the same

[boron]

For days of Reglan is enough for NMS...
QUOTE from emedicine.com/Med/topic2614.htm
"The syndrome can occur after any duration of treatment, although two thirds of cases occur within the first week."

But NMS should go away shortly after the drug removal. There are other side effects of Reglan, which may be the cause.

Liver enzymes may need quite some time to drop to the normal level.

Autoimmune hepatitis or eventual other liver damage can be only checked by liver biopsy and hystologic examination.

But, as I understand you, abdominal pain and weight loss occured before Reglan, right?

Weight loss is either from
- loss of appetite
- malabsorption - STOOL FAT TEST would show excessive fat
- cancer: there are many characteristic substances in the blood, which speak for cancer. They are called "cancer markers". Specific tests should be done to find them, probably by oncologist.  

[funkyblond]

She was taken off the Reglan after the side effect a couple weeks ago. We know that was part of the problem, but not the original problem. She was on Reglan for four days! What a deal.

[boron]

REGLAN
reglan
Reglan
RegLan
R-E-G-L-AN.

OK?
Reglan.

Why not start from what is obvious?

[funkyblond]

The doctor just came in and is thinking autoimmune hepatitis. Labs came back that it doesn't appear to be viral, but could be from medicine. What a long route. We are hoping this is the answer, but have not really had good luck with diagnoses in the past six months.
Now, if it is, we will have to monitor the steroids carefully as there appear to be quite a few side effects.

[boron]

Ativan is actually used in treatment of neuroleptic malignant syndrome, so it should not be problematic, but Reglan is.

Reye syndrome is not likely, I've checked again.

Read these article, it shows causes, risk factors, culprit drugs, laboratory findings, including elevated liver enzymes:

http://www.emedicine.com/Med/topic2614.htm
(it's another version of above mentioned article)

[funkyblond]

Thank you for the ideas. She was taking Ativan that they gave her because they thought there were anxiety attacks.
We don't know if there is a liver disease, but the doctor's indicated that some sort of liver disease may be present to cause these numbers/results.

[boron]

So, all this started after Reglan? Was she taking any other drugs at that time (for anxiety maybe...?)

Liver disease mentioned, was it Reye's syndrome?

I've found connection between Reglan and Neuroleptic malignant syndrome

Just look at these search results:
http://search.yahoo.com/search;_ylt=A0geu8mW_kBI8XsAVhpXNyoA?p=Neuroleptic+malignant+syndrome+reglan&fr=ush-mailc&ei=UTF-8

Read this article (or serach for others):
http://www.emedicine.com/emerg/topic339.htm