STEWIE! Or others

[phatkid77]

Gf admited to hospital. With inflamed liver

Been bed ridden for 2 wks. No work. Fever and sweating insanely

Feb 3 she had ALT CHECKED 26 (10-44)

Had the nurse write me down what was elevated. The doctors are cunfused
Not on anabolics
Wellbutrin. Zoplicone and finished up some pantoloc is the only thing different!!

Ferritin levels 2051 (13-150)
Haptoglobin 0.20(0.3-2.3)
Lactate dehyrdrogenase 1130 (120-315)

Any "theories"

I've come up with stills disease
Hemochromatosis
And couple others. Not sure how just came out of nowhere and why


Sent from my iPhone using Tapatalk

 

[Deleted member 121863]

have you read the studies, risks, side effects associated with those 3 Rx drugs? Is it possible she is in the .5% that gets severe sides from those? I know many of those Rx drugs warn of liver problems but not sure about those 3 specifically. Those drugs are still no joke and react/bind with many different receptors (more than researchers fully understand) besides those intended, that is what causes side effects. Hope she comes through ok.

 

[phatkid77]

Yeah. I read that. But has been on them all for years. Except the trial of pantoloc.
I reminded the internist of this new admit to drug protocol. As nothing else is new


Sent from my iPhone using Tapatalk

 

[sazo75]

would be crazy if Stewie was able to figure out what is going on and help her out. How badass would that be? Do yo thang Stew!!

 

[Stewie]

I'm sorry to hear this is going on. Hopefully very soon her attendings can narrow down the pathology of this.

I'm on my way to class here in a few, I'll throw a few thoughts off the top of my head.

Let me start off by saying, I'm not a clinician. At this time, I'm an undergrad in transition to become a P.A. Given that my diagnostic skills are somewhat limited and mainly based off of discussions with friends of mine that are physicians. As well, self taught through thumbing through acquired medical books. Nevertheless, I can only base my opinion on the aforementioned and not through clinical diagnosis.

With that said. It's difficult to know exactly what's going on without knowing several other lab parameters and a global assessment such as-- skin lesions or rashes, pupil dilation, respiration rate, O2 levels, B.P/HR and other lab's such as a CBC, kidney and liver function tests. In isolation, these tests you provided are nonspecific on a particular pathology. In this case, at least for myself, other lab's would be helpful to determine what's going on. Try not to let any Google searches lead you to believe there's some sort of metastatic state. Leave this to her attendings or hematologist to determine this. If she's been seen by a hematologist?

With those three lab's it's apparent that she has some sort of systematic inflammation or infection going. I haven't looked at the potentials of the Rx's she is taking. Tho, I would look towards the possibility of an acute onset autoimmune disease, such as drug induced lupus erythematosus or hemolytic anemia.

Has there been any imaging done? I do have to get. Please keep us updated!

Gotgame opinions?

 

[asteelz]

often with drug induced liver inflammation the cause of said inflammation is related to the immune system and subsequent systemic response. time under the eye of the attending physicians will tell.. my guess would be an acute immune response to the combo of drugs.

proton pump inhibitors usually have major interactions with anti viral drugs, but doesn't mean they cant with others.

 

[LK3]

funny how so much is related to inflammation/autoimmune...:lightbulb:

I am seeing a lot of ppl get kicked in the ass with something like this, degeneration/autoimmune stuff is huge problem and getting worse.

modern diet and life style are largely to blame.

if related to the above there is no overnight fix, most drugs used to treat really go the other way. sucks, just hard personal work to fix it.

I think better to not treat symptoms so much but...
if related to liver stress/inflammation there are very simple ways of addressing this. simple nac can do a lot. that said deal with drs n don't go fuckin with shit randomly on your own.

 

[phatkid77]

Suspecting mono. Enlarged spleen


Sent from my iPhone using Tapatalk

 

[phatkid77]

I wan t to bring up hemochromatosis tho as per the ultra high ferretin lvels


Sent from my iPhone using Tapatalk

 

[Stewie]

I wan t to bring up hemochromatosis tho as per the ultra high ferretin lvels


Sent from my iPhone using Tapatalk

Yeah, you could think that, although it's not diagnostic for hemochromatosis.

Ferritin is an acute phase reactant. Meaning if there's an infection or inflammatory response going on, ferritin will rise in response. So it's nonspecific.

As for her having EBV, I'm surprised they didn't pick up on that with her WBC- differentials-- lymphocytes and her alkaline phosphatase levels. Then again, depending on the time frame and duration of the onset of EBV these values may not of shown any concerns, as of yet.

I'm sure they'll do a heterophile test to confirm EBV (mononucleosis).

 

[ALLEX]

Enlarged spleen

Polycythemia Vera?

 

[TheOutlier]

I wan t to bring up hemochromatosis tho as per the ultra high ferretin lvels


Sent from my iPhone using Tapatalk

Most likely there would be more involved, diagnosing hemochromatosis solely off of elevated ferritin is very uncommon.
Is there a hereditary disposition?
Thyroid disease?
Reproductive issues? absence of menstruation which could lead towards unwanted iron accumulation, etc.
Ethnicity?
History of alcohol abuse? Drug abuse? NSAID abuse, or chronic use of
The list continues..

Any physical changes, skin pigmentation, sclera of the eye, anything that you have noticed?

As Stewie indicated, what imaging has been performed? Additional testing, lab values...?

These threads always provide great conversation, knowledge, and encourage a productive thought process but in reality her health care providers are your best bet.

 

[TheOutlier]

Polycythemia Vera?

Doubtful, would most likely present tachycardic with accompanying low oxygen saturation, or at least some cardiovascular or pulmonary component would have been mentioned

 

[Stewie]

Polycythemia Vera?

Splenomegaly (enlarged spleen) is very common with mononucleosis.

 

[TheOutlier]

Yeah, you could think that, although it's not diagnostic for hemochromatosis.

Ferritin is an acute phase reactant. Meaning if there's an infection or inflammatory response going on, ferritin will rise in response. So it's nonspecific.

As for her having EBV, I'm surprised they didn't pick up on that with her WBC- differentials-- lymphocytes and her alkaline phosphatase levels. Then again, depending on the time frame and duration of the onset of EBV these values may not of shown any concerns, as of yet.

I'm sure they'll do a heterophile test to confirm EBV (mononucleosis).

:lightbulb: I must have been replying as you submitted this, I would have not responded had I read this first

 

[Stewie]

:lightbulb: I must have been replying as you submitted this, I would have not responded had I read this first

The more the voices, the better the understanding. Glad you chimmed in

 

[phatkid77]

Yeah, you could think that, although it's not diagnostic for hemochromatosis.



Ferritin is an acute phase reactant. Meaning if there's an infection or inflammatory response going on, ferritin will rise in response. So it's nonspecific.



As for her having EBV, I'm surprised they didn't pick up on that with her WBC- differentials-- lymphocytes and her alkaline phosphatase levels. Then again, depending on the time frame and duration of the onset of EBV these values may not of shown any concerns, as of yet.



I'm sure they'll do a heterophile test to confirm EBV (mononucleosis).

Feb 3 she was negative for mono
They did two spot tests. But something happens with her blood to quick for it to register... So they sent it to the lab for a more accurate result


Sent from my iPhone using Tapatalk

 

[phatkid77]

And to further add. She did go MONTHS without a period during prep and she only just recently had one like a month ago? So didn't have period for I bet. Close to 6months?
I've read for hemochromatosis that a panel needs to be done for accurate diagnosis. Not each one Independant of one another. And that for women it's usually after 10+ years post menopausal.
Hoping for mono in any even

I'd love to know all her values. But I'm sure internal medicine knows more than I'll find. But never hurts to have opinions and theories


Sent from my iPhone using Tapatalk

 

[TheOutlier]

Very possible that the monospot returned negative due to timing, which in that case the results of the EBV antibody may produce a different result.

phatkid77, In your initial post, was she bed ridden for 2 weeks w/fever and excessive sweating prior to her hospitalization 2/03/2016 or after? Has she been feeling well prior to this episode, or is this something that has accumulated over a period of time? (e.g. general malaise, lethargy, etc.)

 

[ALLEX]

It does sound like something autoimmune.

I saw a guy with bad jaundice recover pretty fast with Synthergine, so you could try that.

Do you have her thyroid numbers? Complications from Graves?