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Metabolic causes of neurological symtoms

  I been having the following neurological problems
  1. Pain that come and goes, localized in my arms and legs
  2. Most of the pain in the forearms and the shins, but its
     spreading down in to my hands and feet.
  3. Senatations of burning and itching all over the body
  4. Can not stand for any length of time without having
     bottom of my feet burn so much that I have to sit
     or lay down.
  The reason for the question of metabolic causes is that
  my liver function test are abnormal and I am experiencing
  some form of secretory diarrhea.
  One important note:
  If I take any anti-motility drugs, my neurological symtoms increase and
  I have bout of stupor and only when I take high doses of flagyl do
  the bout of stupor stop.
  Generally antibiotic tend to help how I feel for short durations.
  Test          Readings Range
  ALT           88-170   (21-72)  Alway High
  Lipase        367      (23-300) Always High
  Cholesterol   309      (0-200) I am not obese,values normal 1 year ago
  Triglycerides 495      (0-200) I am not obese, values normal 1 year ago
  AMSA          1:20     (< 1:20) ??
  Ferrition     30       (33-236) This has been droping
  Bicarb        30-34    (22-30) Always High
  Urine Test
  Calcium       38.5     (100-300) This is always low even though
                                   my total serum calcium level if ok
  Creatinine    2.45      (.8-2.0) Always High
  Negative for viral Hepattis
  1. What substances release either from the liver, pancreas (bile??) or
     gut can cause neurological symptoms when they reach the blood.
  2. The fact that the pain is mostly in the forearms and shins have
     any relevance?
  3. What test might be usefull looking for a systemic agent causing this
     type of response.
  Any help is greatly appreaciated.
Dear Sudhir:
Sorry to hear about your problems.  Do you know the etiology of your liver failure?  What viral etiologies of liver failure have they ruled out?  Yes there are secreted products that can cause the symptoms you are experiencing.  The high level of ammonia can cause encephalopathy, the bilirubin can cause severe skin itching, the rise in your cholesterol and lipids can be seen in liver failure, etc.  The high level of lipase does not necessarily mean that you have pancreatitis, but it can given the context of abdominal pain and a compatible physical exam.  Likely, there is no real relevance to the area of symptoms, but in that your having them is important.  The etiology of your liver failure has to be addressed.  Until one finds this, it is hard to know what therapies would be best.  I would suggest that you persue the diagnosis of what is causing the liver not to function correctly.  The ammonia can be reduced by phenylacetate or sodium benzoate, or the use of carnitine and lactulose.  But this will not
get rid of your major problem, that of organ failure.
CCF Neuro[P] MD, RPS

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