Spryte Posted June 23, 2014 Share Posted June 23, 2014 My mom's doc called her on a Sunday, to discuss this with her. Her liver numbers are ten times the normal range. Very high. (I'm guessing she means liver enzymes, but not positive as I'm not with her in person.) She had recently started trazadone, for sleep (as an alternative to ambien), so she's stopping that, and we're hopeful that's the cause. Trazadone lists liver issues as a very rare side effect, so it's possible. She's also stopping her blood pressure medication, since her BP has been on the low side for a while now. She's going to see her doc this afternoon. What else should be ruled out? Anything else she should ask? She's been exhausted and weak for a few weeks. She fell about a month ago, but nothing was broken. Big, hard fall though. She's 73, but very active and mostly healthy. BTW, hepatitis has been ruled out, and she doesn't drink at all. She is not diabetic (she was Type II years ago, but turned it around with diet, and monitors it closely - those numbers are all good right now). Any thoughts? I am very worried. This is a trigger for me, as I lost my best friend of many years to liver disease. Quote Link to comment Share on other sites More sharing options...
Ethel Mertz Posted June 23, 2014 Share Posted June 23, 2014 Maybe a cyst on her liver? They'll probably want to do an ultrasound to rule out cysts and tumors. Maybe someone else will have another suggestion. I'm hoping it's the medication. Quote Link to comment Share on other sites More sharing options...
Jean in Newcastle Posted June 23, 2014 Share Posted June 23, 2014 Is she stopping trazadone on doctor's orders? Is she being tapered off? There can be bad withdrawal symptoms if she stops abruptly (probably depending on how much she's been taking for how long). Quote Link to comment Share on other sites More sharing options...
Spryte Posted June 23, 2014 Author Share Posted June 23, 2014 Is she stopping trazadone on doctor's orders? Is she being tapered off? There can be bad withdrawal symptoms if she stops abruptly (probably depending on how much she's been taking for how long). Yes, on Sunday the doc told her to taper off the trazadone. It will only take 3 days, as she hasn't been on it long, nor is she on a high dose. Quote Link to comment Share on other sites More sharing options...
Catwoman Posted June 23, 2014 Share Posted June 23, 2014 Without knowing any specifics, I don't have any good ideas for you about the cause, but my one and only super-important, absolutely-urgent recommendation is to get your mom in to see a good hepatologist immediately. Don't let a regular doctor deal with liver problems. Your mom might have an excellent doctor who knows all about it, but most of them really don't even if they act like they do, and finding out what's wrong immediately can make all the difference in the world when it comes to preventing permanent damage. If there is a liver transplant center in your area, call and let them know what's going on, and ask for a recommendation about what to do next. (Please don't panic -- I'm NOT suggesting your mom is going to need a liver transplant!!! I'm just saying to call so they can advise you on what to do next and recommend a doctor.) I'm hoping this is just a temporary reaction to medications, but even if it is, it needs to be treated properly. Sorry to be so pushy about this, but my dh has advanced liver disease and I know from a lot of experience that getting the right doctor quickly is incredibly important. Please update us when you can! :grouphug: Quote Link to comment Share on other sites More sharing options...
gardenmom5 Posted June 23, 2014 Share Posted June 23, 2014 acetaminophen is also a known cause of liver damage. if she takes it (for anything) - she needs to stop asap. Quote Link to comment Share on other sites More sharing options...
LMV Posted June 23, 2014 Share Posted June 23, 2014 If she is talking about liver enzymes (aka transaminases--ALT and AST) elevation of these usually represents (often) acute liver injury or inflammation, although AST can be elevated with acute MI, renal damage, trauma, acute pancreatitis as well. One thing to remember is that the two good measures of liver function are not the transaminases but albumin level, and the Prothrombin time. When liver function is impaired the albumin will be low and prothrombin time will be prolonged (because albumin production and certain clotting factors require a healthy liver for optimal production). I presume that your mom's doctor likely got an albumin (and likely electrolytes and creatinine which would give a proxy for renal function) on the same CMP that revealed her elevated transaminases. If they didn't check a PT/INR that would be reasonable as would a CK to exclude a musculoskeletal etiology for the AST elevation (especially if the ALT is not significantly elevated) Repeating the CMP and obtaining an ultrasound to look at the liver would also be reasonable. Based on these tests then they should be able to determine an appropriate referral and timeframe if necessary. I do agree with others that avoiding Acetaminophen would be helpful. Is she taking any of the statin medications? That might be another explanation (although usually statins don't raise levels into the 400s where it seems your mom's levels are). One final thought if labs do show that liver function itself is indeed compromised then you may want to ask about NASH or Non Alcoholic Steatohepatitis. This is seen more commonly in diabetics, the obese, and those with metabolic syndrome. Quote Link to comment Share on other sites More sharing options...
Spryte Posted June 23, 2014 Author Share Posted June 23, 2014 Thanks so much, everyone. She is heading to her doc now, and taking a list of things to discuss, lots of ideas from this thread. She is not taking acetaminophen, but she was most certainly using Aleve, possibly Advil (though probably not together). I'm not clear on how often but she's stopped both of those for now. She will ask about NASH, too, LMV, and about the specific tests (she is getting copies of all labwork results). Catwoman, I will encourage her to go to a specialist. Thanks, all, for helping me think this through with her, and stay calm. Quote Link to comment Share on other sites More sharing options...
TechWife Posted June 23, 2014 Share Posted June 23, 2014 Sorry to be so pushy about this, but my dh has advanced liver disease and I know from a lot of experience that getting the right doctor quickly is incredibly important. Amen to this! My brother in law had Alpha 1 Antitrypsin Deficiency. From the time he started showing symptoms to diagnosis was over six months. He died about five months later as he quickly went from not being sick enough for a liver transplant to being too sick for one. Liver disease needs to be monitored very quickly. Quote Link to comment Share on other sites More sharing options...
Spryte Posted June 23, 2014 Author Share Posted June 23, 2014 Amen to this! My brother in law had Alpha 1 Antitrypsin Deficiency. From the time he started showing symptoms to diagnosis was over six months. He died about five months later as he quickly went from not being sick enough for a liver transplant to being too sick for one. Liver disease needs to be monitored very quickly. :grouphug: I'm sorry about your brother in law. My best friend made it 8 months to the day from diagnosis (liver issues/rare blood clotting disorder) to passing away. She did not get diagnosed quickly at all, and earlier diagnosis may have made a difference. I miss her. Quote Link to comment Share on other sites More sharing options...
Catherine Posted June 23, 2014 Share Posted June 23, 2014 Also, the pattern of the enzymes will help to distinguish between an obstruction, like a gallstone, and damage to the liver cells themselves, like what happens when a drug causes liver damage. Quote Link to comment Share on other sites More sharing options...
Spryte Posted June 23, 2014 Author Share Posted June 23, 2014 So it looks like there was a drug interaction, probably Trazadone and a statin drug. That's probably the best case scenario, right? They will retest in a few days and if the numbers are not going down she'll go to a specialist. Quote Link to comment Share on other sites More sharing options...
Catwoman Posted June 23, 2014 Share Posted June 23, 2014 Thanks for the update! Keep a close eye on her. Make sure she doesn't start retaining fluids (ankles, feet, abdomen,) and that her mind stays lucid. Those are the biggest concerns -- they're treatable but you want to catch any symptoms very early. Also, make sure she's well hydrated. The worst thing for her would be to get dehydrated. Quote Link to comment Share on other sites More sharing options...
Ottakee Posted June 24, 2014 Share Posted June 24, 2014 Hoping it is the meds. My daughter had this with Depakote. Rare but of course happened here. Stopping it cleared it up. Her doctor though thankfully thought to test it shortly after starting the med. Quote Link to comment Share on other sites More sharing options...
Catwoman Posted June 24, 2014 Share Posted June 24, 2014 Hoping it is the meds. My daughter had this with Depakote. Rare but of course happened here. Stopping it cleared it up. Her doctor though thankfully thought to test it shortly after starting the med. That's so scary! :grouphug: Thank goodness her doctor was keeping a close eye on things and caught the problem early. Quote Link to comment Share on other sites More sharing options...
Spryte Posted June 24, 2014 Author Share Posted June 24, 2014 Thanks for the update! Keep a close eye on her. Make sure she doesn't start retaining fluids (ankles, feet, abdomen,) and that her mind stays lucid. Those are the biggest concerns -- they're treatable but you want to catch any symptoms very early. Also, make sure she's well hydrated. The worst thing for her would be to get dehydrated. I told her to watch for these things (I'm not local). She says to tell you "thank you!" :) Quote Link to comment Share on other sites More sharing options...
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