With stage 4 cirrhosis, I wonder if this could be a manifestation of HE (hepatic encephalopathy). Is he taking Lactulose right now? Has he had any confusion or issues like getting lost or combative? Who did he see most recently for the dizziness/dehydration? His primary care guy or a GI doc? Has he had labs in the past that showed an increase in serum ammonia, by chance?
HE can be precipitated when the liver can no longer manage ammonia produced by the colon as a byproduct of protein metabolism. Animal proteins can cause ‘meat drunks’ in cirrhotics. Apparently, years ago meat consumption was discouraged in decompensated cirrhotics, but there are meds to manage this now. This is purely speculation on my part, of course, and this could be due to something else entirely. Have him contact his GI or hepatologist, but he could mention this as a possibility.
Best of luck—
Thanks Bill I can usually count on you! On 6/1 he saw the primary care doctor. But he has had some confusion lately. Sometimes he will ask me things that I had told him only 2 hours earlier. He told me he will even be in the shower and just washed his face and can't remember if he did it or not. And yes wanting to argue about everything.
He was going to Mayo here in Jacksonville and I have all the latest blood work but it is at home, just took them out of my car yesterday! Do you know what the code is for the ammonia test by chance? I will look it up tonight.
No, I don’t know any test codes for serum/plasma ammonia; sorry. HE can be tricky stuff to diagnose, from what I understand. It’s quite possible to have significantly elevated levels of ammonia and not present with HE, and conversely to have very low levels and significant HE. My understanding is that while ammonia isn’t always diagnostic for problems it is associated with them.
He might want to reduce animal proteins for the short term, just in case. It won’t hurt to exchange red meat for legumes for the interim, until he can be seen, eh? Did he chow down on a big BBQ w/roast beast while fishing?
And it’s important to emphasize again, this is only speculation on my part; I’m *very* far from being a medical professional :o). Summer is here, and he could have been caught with a little heat stroke too, something like that; and nothing at all to do with his liver disease.
All the best to you both—
The fishing was only a 1 day thing with my brother and nephews. But I am now trying to figure out what he may have eaten around that time. When he saw the doctor, (of coarse the one and only time I didn't go with him) he asked about the ammonia level. I have since dropped off a copy of everything to that doctor, but I haven't heard anything.
I found out is is coded NI-13 or NI-14. It seems to me they were elavated and that was before the fishing.
I’d be interested to know how this turns out, Patti; drop me a note later if you think of it.
If it ends up as HE, it can often be managed with Lactulose and other meds. Best to both of you,
Bill is correct. It could be dehydration (most common) or something else.
Dehydation is very common, especially if your husband is taking diuretics to prevent ascites and edema. Both of these are common symptoms of later stage cirrhosis.
The Mayo clinic and a hepatologist will be up to date on all of these issues so I am sure they will provide your husband with the meds he needs to manage his cirrhosis.
If your husband has problems remembering things it is very possible he is suffering from HE (Hepatic Encephalopathy). This is a common symptom amongst cirrhotics. Meds to manage and prevent episodes of HE are Lactulose (patients should take enough lactulose as to have 2-4 loose stools per day) and Rifaximin (an anti-biotic).
Most patients with cirrhosis will develop some degree of HE during the course of their disease, with up to 45% developing overt HE and up to 80% developing minimal HE.
Ammonia and zinc levels are measured from blood samples. They must be asked for. They are not common blood test that are performed routinely. Ammonia is listed as Ammonia on my blood tests. The normal range is 7-35 UMOL/L. Since you have some blood work you may want to look at his Platelet count, INR, Bilirubin, and Creatinine. This can help give you an idea of your husband's liver ability to function.
NOTE: Ammonia levels don't always correlate with HE. Or the Grade of HE. The most accurate way to diagnose HE is based on behavior changes. Again Mayo clinic will be aware of this.
HE is caused by poor liver functioning. Since the cirrhotic liver is not working properly it is unable to clean the blood coming from the digestive system so the toxic substances are able to pass into the brain.
Grades of Hepatic Encephalopathy:
• Grade 0 - Minimal hepatic encephalopathy (previously known as subclinical hepatic encephalopathy). Lack of detectable changes in personality or behavior. Minimal changes in memory, concentration, intellectual function, and coordination. Asterixis is absent.
• Grade 1 - Trivial lack of awareness. Shortened attention span. Impaired addition or subtraction. Hypersomnia, insomnia, or inversion of sleep pattern. Euphoria, depression, or irritability. Mild confusion. Slowing of ability to perform mental tasks. Asterixis can be detected (If a patient tries to put both hands out in front of themselves indicating "stop" their hands will flap at the wrist).
• Grade 2 - Lethargy or apathy. Disorientation. Inappropriate behavior. Slurred speech. Obvious asterixis. Drowsiness, lethargy, gross deficits in ability to perform mental tasks, obvious personality changes, inappropriate behavior, and intermittent disorientation, usually regarding time.
• Grade 3 - Somnolent but can be aroused, unable to perform mental tasks, disorientation about time and place, marked confusion, amnesia, occasional fits of rage, present but incomprehensible speech
• Grade 4 - Coma with or without response to painful stimuli
Diets containing vegetable proteins appear to be better tolerated than diets rich in animal protein, especially proteins derived from red meats. Chicken and fish in addition to vegetable protein appear to be fine also.
Best of luck!
i had this it lasted for a year , i had loads of tests they never got to the bottom of it, it really was difficult to live with and got me down its a horrible experiance, i hope you sort it soon