Posted By HFHSM.D.-D.M. on June 08, 1999 at 18:04:22
Dear Bob Kovich:
I appreciate your concern for your mother and your questions.
As the liver fails, ammonia and other chemicals (that are typically cleared by the liver) rise in the blood. Many patients with high ammonia levels from liver disease develop a condition called hepatic encephalopathy and develop symptoms such as forgetfulness, confusion and lethargy. However, surprisingly, the level of the ammonia does not always correlate with the severity of someones hepatic encephalopathy. Some individuals tolerate high ammonia levels with little confusion whereas others will have severe problems with only mildly elevated ammonia levels. In fact, what we are much more concerned with is our clinical assessment of the patient. . I am a liver specialist with access to a quality lab and I hardly ever get an ammonia level on my patients.
If a patient appears fully oriented, alert and conversant at a high level, we dont necessarily get that concerned about a high ammonia level. I would also point out that ammonia levels are relatively sophisticated tests to perform and I would be surprised that your nursing home can even obtain one accurately. I would also point out that some patients have more subtle signs of hepatic encephalopathy including fatigue, trouble sleeping and inability to concentrate. These symptoms sometimes respond to a relatively small doses of a drug called lactulose.
Your question about advil and Tylenol are excellent ones. Believe it or not Tylenol is a surprisingly safe drug for people with chronic liver disease provided it is used in prescribed doses and provided there is no alcohol use. Advil is often safe in liver patients as well provided there is kidney disease, history or stomach ulcers or platelet or bleeding problems.
The decision about leaving the nursing home is really one you will have to make in discussions with your mother and her physicians. I dont know if she would be alone at home or if there will be other people to help her should she get into trouble. You havent told me anything about her liver condition that suggests it would be an obstacle to not being in a nursing home.
I hope this information is helpful to you. Good luck with your situation. If you have additional information or questions, I would invite you to post the material to MEDHELP . The direct number to our Liver Clinic at Henry Ford is (313) 916-8865. We have an active group of liver specialists.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
Ammonia level bob kovich 6/10/1999
Re: Ammonia level HFHSM.D.-D.M. 6/17/1999