Liver Disorders Community
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Elevated direct bilirubin, hypotension, bradycardia

I'll try to keep this simple.  History of alcohol abuse (12 years), previously had fatty liver / elevated AST/ALT mild bilirubin elevation (total/indirect).  Gave it up for 2 months, came out on 200mg seroquel for sleep and relapsed.  

Gradually lost 10% weight over 12 months.  Occasional abdominal pain (liver area).  Always same spots.

9 months ago - Abdominal CT and ultrasounds normal

8 weeks ago - Started having strange symptoms, itching, brain fog, etc.  Found bilirubin was elevated 2.6 total, 0.7 direct.  AST/ALT and pretty much everything else normal.  Cut down.

6 weeks ago - quit alcohol, tried naltrexone 50mg/day.  Had bad hypnagogic reactions falling asleep, woke up in night terror type situation, found super low BP, triggered anxiety, ER visits, etc.  Was found mildly dehydrated (despite drinking tons of water), low potassium, mildly elevated TSH, the usual bilirubin result.

Last 4 weeks - 0 alcohol.  Cut seroquel from 200 to 25mg/day for 10 days, then quit.  0 seroquel for past 10 days.  Entire 4 weeks I've had hypotension (regularly 100/60, sometimes 95/55.  Borderline bradycardia (55 resting heart rate especially at night).  Symptoms from orthostatic hypotension (dizziness upon standing).  Symptoms of postrandial hypotension (crash after eating, even with low carbs/balanced).

Now I've had a suite of blood tests.  Everything normal - TSH came back to normal.  Electrolytes are fine.  CBC is fine.  Things like ammonia, GGT, all kinds of stuff normal.  

What I'm left with is continuing hypotension and orthostatic hypotension symptoms, a bilirubin level that has gone up even more after quitting everything (most recently 3.1 total, 0.7 direct), and what is a strangely low heart rate for me.  I work on a computer 14 hours a day and rarely exercise.  I don't think my pulse should be sitting in the 55-65 range and I don't feel good when it is.  

I have checked glucose a few times after eating and along with other tests were typically fairly normal (on the lower end).  Recently had a holter and ECG without results yet.  In general, no idea what's going on.  

Any ideas?  

1 Responses
Avatar universal
You need to get your doctor involved wrt tracking down your bilirubin elevations. The past alcohol usage may have left you with a fatty liver. But other possibilities should be considered as well, such as Gilbert syndrome, etc.
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