Encephalopathy Education

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1Shelly1
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Date Joined Oct 2007
Total Posts : 502
   Posted 2/25/2008 7:52 AM (GMT -7)   

I am a huge advocate of patient and caregiver education as most of you already know. Several weeks ago a question came up on the forum about Encephalopathy. As I read the posts I see some repeated similarities concerning certain symptoms that I think are specific to the possibility of them being related to encephalopathy. This is debilitating for anyone who suffers from it. So I thought that I would put the symptoms out here again. It usually starts with some subtle changes that caregivers notice after awhile like memory loss, poor concentration, extreme tiredness, lack of interest in daily activities, and some cognitive loss and daytime sleepiness.Patients often describe flu-like symptoms that includes muscle aches and pains. Personality changes are some of the first signs. As it worsens the person may suffer from muscle twitching in one muscle or a group of muscles called “myoclonus”, they may also suffer from very rapid eye movement (the eyes are actually twitching up and down and side to side) this is called “nystagmus”. (Nystagmus causes severe nausea and vomiting because it makes the person feel dizzy). Sometimes the affected person gets tremors, muscle weakness, some dementia, difficulty swallowing, inability to speak, and possibly seizures. Permanent brain damage is a possibility. Coma can follow and it can result in death. Now keep in mind that this is a candid list of potential symptoms. By no means am I implying that everyone with encephalopathy will have all of the symptoms listed.  

The exact cause of hepatic encephalopathy is really unknown. What they do know is that in cirrhosis or hepatitis blood circulation does not enter the liver properly or adequately. As a consequence of improper circulation to the liver the toxins that are normally metabolized and eliminated by the liver are now collecting and increasing all the time building up in the bloodstream. This buildup of toxins causes the encephalopathy. When someone has end stage liver disease this can and usually does become chronic. This is the main reason that Dr’s don’t want to give Liver failure patients barbiturates or any sedatives. They can’t metabolize them properly and again it causes toxic effects. Also, most patients are on low protein diets because the protein can’t be metabolized properly. There are other factors that can increase symptoms such as a GI bleed, infections, kidney disease, etc.

I hope this helps a little in understanding what is going on with encephalopathy. I know that there are times that information is overwhelming but eventually it’s like the “AH HA” experience and you “get” it.

 

  Shelly


CaryF
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Date Joined Nov 2007
Total Posts : 505
   Posted 2/27/2008 9:45 AM (GMT -7)   
Thanks for this excellent info Shelly, you sure know your stuff!

As a Hep C patient I have experienced episodes of encephalopathy and learnt to dramatically reduce protein in my diet (my AH HA) . I've not experienced a bout since. Even strict vegetarians can get plenty of protein in their diet with beans, some vegetables, peanut butter, soy products. I know Hep C folks that that mistakenly think they should ADD protein with protein drinks as they can have poor appetites and diet.

My health has definitely improved with my severe reduction of protein.
I'm not a complete vegetarian, but its a cheap(er) and easy way to help our livers & improve overall health for us folks with compromised livers. Meat is out for me & its pricey!

Cary

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 3/1/2008 7:42 PM (GMT -7)   

Shelly, thanks for all the info!  You are a treasure and so appreciated at this forum.

Since I've never had episodes of encephalopathy, what is causing the fatigue I've been experiencing since about '89--about 3 years prior to being diagnosed with hep C?  I assume it's my compromised liver function, yet all of my labs now are great...and I still have that darned fatigue.  It's always there, regardless of how much sleep I get or whether I've been busy or just laying around watching TV or reading.  It's a "bone weary" feeling.  It's not as bad since the right lobe of my liver was removed, along with the cancer...but it's still there and certainly not "normal" for the average person.

I know you're not a doctor, but as a nurse you do have valuable information and insight.  What is your opinion as to the fatigue?

Hugs,

Connie

1Shelly1
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Date Joined Oct 2007
Total Posts : 502
   Posted 3/2/2008 5:43 AM (GMT -7)   

Hi Connie, I'm sorry you're so fatigued-it's like a big merry go round that you can't get off of isn't it? Fatigue is really common because there are so many causes. I'll list a few of the more typical little devils that bring on this total exhaustion OK? Hormone Imbalances (peri menopausal and menopausal women), different types of diets, disrupted sleep (for us girls it's usually bathroom trips to pee), anxiety, depression, poor thyroid function, stress, chronic fatugue syndrome, sleep apnea, certain medications that slow or inhibit REM sleep, anemia, too much caffeine, and allergies. This list is virtually endless. My first reaction would be to have your thyroid checked since this is really common for underactive thyroids. If that is OK then I would ask my Dr for a referral to a sleep clinic. As you know fatigue can completely wipe us out if it goes unchecked. Hope this helped.

 Shelly


exhaused
Regular Member


Date Joined Nov 2007
Total Posts : 445
   Posted 3/2/2008 8:56 PM (GMT -7)   
Shelly-I know exactly what you are saying about the protein.  What you have said everyone else has told us and I thought I had it all figured out.  Then we made the trip to Vanderbilt on Wed and pretty much got chewed out by the Dr.  He wants Jerry to eat every bit of protein he can get his hands on.  If he starts showing sings of encephalopathy he said DO NOT BACK OFF THE PROTEIN!  He told me to just give him more lactalose.  He is the ONLY Dr. through this entire experience that has told me to do this.  Why to you think that is?
 
JoAnn

Butterflythree
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Date Joined Oct 2007
Total Posts : 954
   Posted 3/2/2008 9:27 PM (GMT -7)   
Hi JoAnn, From what I have read doctor's disagree on protein and the damaged liver. I have also read that protein from other sources besides meat is ok. I'm sure there are disagreements on this also. Everything can be so confusing.
Butterflythree
 
There is always hope!


1Shelly1
Veteran Member


Date Joined Oct 2007
Total Posts : 502
   Posted 3/3/2008 5:28 AM (GMT -7)   
JoAnn, Butterflythree is right-it is very confusing but to some degree I understand . They are learning new things everyday and some Dr's are at times reluctant to change their minds until the newer concepts are more widely practiced. Your Dr at Vandy may have the newest info and more readily willing to change. I don't know for certain that  is the case but that's my guess. He may feel that the consequence of low protein is unmanageable whereas the high amonia levels from high protein can be managed with an increase in lactulose. He is the expert and I would follow what he says.

Pink Grandma
Veteran Member


Date Joined Nov 2006
Total Posts : 2445
   Posted 3/3/2008 7:01 AM (GMT -7)   
Shelly hit the nail on the head. We got the same thing. He GI doc said low protein (older doc) but when his Hep doc (younger doc) took over it was high protein. But he did said to limit the red meat though. When I asked about the discrepancy the Hep doc said that in effect the low protein way was like "old school". That they are finding out it was better to for the patient to eat high protein. Doctors are no different. They don't like change either.
So we did eliminate the read meat for the most part. And I would cut back on the protein if he started getting looney. He hated the lactolose and it was hard enough trying to get him to take it as it was ordered. And come to think of it. He didn't experience the extreme muscle loss that some liver patients do although he did have some. But he always had a pretty appetite until the end.
Thoughts and prayers.
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


exhaused
Regular Member


Date Joined Nov 2007
Total Posts : 445
   Posted 3/3/2008 9:49 PM (GMT -7)   

You guys are right.  We have been told by Vandy Dr. to watch the red meat.  We don't eat red meat much at all.  I make him smoothies with both Whey protein and soy.  I think the soy is much better for him.  The big problem according to the Dr. is his body is eating itself.  He has no muscle mass left at he has lost almost 80 lbs.  So thats the reason for dumping on the protein.  He can tell when his ammonia is starting to rise.  He always figures different ways to drink his lactalose.  His latest is in a small amount of sprite.  He always heats some peanut butterr with crackers also.  We just got back from Vanderbilt to meet again with the head Physicriast and she has recommended Jerry for the transplant list.!!!  We are so excited my daughter wanted to have a party!! (no liquior ofcourse)!!!  WE are going to celebrate  by driving to our second home on the coast and get some R and R.  Hopefully Jerry can tolerate it.  He needs to see it done.  He's not been able to and has worked so hard all his life for this.    Thank you all for your continued love and support and be sure when we get the letter I will let you all know.  Also his MELD score is a 17 but he's in much worse shape then that.  His blood type is O which they said can help him.  I'm so excited I could go on and on all night.  I will write you from the Beach I have a computer there.  Thank you all for helping me get through I just coudn't have done it without you.

 

JoAnn

 

Rainbeau where are you  I worry when I don't hear from you!!!!


Pink Grandma
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Date Joined Nov 2006
Total Posts : 2445
   Posted 3/3/2008 10:04 PM (GMT -7)   
yeah yeah yeah Alright JoAnn. Great news. Have a nice restful time at the coast. Thoughts and prayers.......... :-)
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


frustrated_n_wv
Regular Member


Date Joined Aug 2006
Total Posts : 469
   Posted 3/4/2008 4:40 AM (GMT -7)   
Joann

Congrats to both you and Jerry and your exciting news. Emjoy your time away and get some R & R. I am sure this news will make this trip even more special

Lucy

1Shelly1
Veteran Member


Date Joined Oct 2007
Total Posts : 502
   Posted 3/4/2008 5:56 AM (GMT -7)   

JoAnn, I am so happy for you both....that is great news. Have a blast at the beach house.

 Shelly


Butterflythree
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Date Joined Oct 2007
Total Posts : 954
   Posted 3/5/2008 9:05 PM (GMT -7)   
JoAnn, That is great news. You both have worked very hard for it. I hope you enjoy yourself on your vacation. My thoughts and prayers are with you.
Butterflythree
 
There is always hope!


hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 7/6/2008 9:23 PM (GMT -7)   

Funny to go back and read old posts.  I am positive now that fatigue is indigenous to those with hep C and liver disease. 

Hugs,

Connie


Judith
Regular Member


Date Joined Apr 2008
Total Posts : 131
   Posted 7/31/2008 10:40 AM (GMT -7)   
Shelly,
 
My husband's doctor put him on Magnesium plus protein and it has really decreased the loss of muscle mass, he also has him on Cod liver Oil and I don't have a clue what that's for confused .
 
 
Judith

mer
Veteran Member


Date Joined Aug 2008
Total Posts : 613
   Posted 9/1/2008 6:07 PM (GMT -7)   
Okay, shelly, and everryone for the input!! We, too, were told by the transplant team that my hubby needs the protein so he can stay "healthy" enough for the surgery.....but I do notice when he eats too much meat....partcularly red meat, his side hurts more then usual, and he gets confused easier that normal. So, it is a balancing act.....I try to do more fish & chicken.....but, good point, he can get the protein for beans, etc, too!!

auntkay
Veteran Member


Date Joined Apr 2004
Total Posts : 1199
   Posted 9/5/2008 3:43 AM (GMT -7)   
Shelly, Thanks for the information on this subject i've been so worried about my hubby.He has many of the symptoms you have described here. I keep telling him he needs to stay under the care of a dr. that treats hepc but he won't listen to me. thanks again
Kay

Mrs.O
New Member


Date Joined Nov 2008
Total Posts : 7
   Posted 11/4/2008 7:09 PM (GMT -7)   
I've just found this forum tonight, and certainly appreciate that I'm not alone.

My question about hepatic encephalopathy is does anyone else have someone who acts mean, when their ammonia levels are high? My husband has ESLD, and when his ammonia is high, he first goes into sleep mode, then when we try to get more lactulose in him, he fights us. He wants to be left alone to sleep, but we have to keep trying, and will end up making him so angry that he starts threatening us with physical harm. He doesn't even look like him when he's like this. It's more like someone sleepwalking, and acting out a nightmare...if that makes sense.

He's in ICU right now. I noticed his ammonia going up 3 days ago, but the doctors called me this morning, telling me they put him in ICU. His ammonia was 260. He's been out of control before, when it's been 180. He responds to any pain today, but doesn't know what's going on. He'll start screaming even when they're just taking his blood pressure. Can't understand a word he's saying. They also have to put his hands in restraints, because he's pulled out nose tubes, catheters, cvl's and anything he thinks is hurting him.

This is the 3rd time he's been in such a serious condition. I think it's all from the high ammonia level, but the doctors keep telling me they believe he's having some type of psychotic episode.

Has anyone else ever experienced this?

Thanks in advance.

mer
Veteran Member


Date Joined Aug 2008
Total Posts : 613
   Posted 11/4/2008 8:26 PM (GMT -7)   
Mrs. O,

First of all I would like to welcome you to the forum! I think you will find this forum very educational and supportive. I am so sorry you are having to deal with this horrible disease. My husband has HepC and cirrhosis and we have had quite the battle with his ammonia levels. Most worst, most recently he was in the hospital a few months ago and he went into a psychotic episode and was very angry, and was trying to pull out IV, etc and was completely out of his mind. I don't want to repeat some of what went on because it was like a really bad dream....they had to sedate him and put him in restraints etc.....I know it's hard to watch, but this is part of the disease. Elevated ammonia can cause behavorial changes, major confusion (encephalopathy), etc and can affect everyone differently. Unfortunately, the lactulose is the key.....what kind of disease does your husband have? is he a transplant candidate??

Will be praying for you and know that you are not alone!

Mary

Mrs.O
New Member


Date Joined Nov 2008
Total Posts : 7
   Posted 11/5/2008 7:22 AM (GMT -7)   
Thank you Mary for answering. I'm glad to hear that my husband isn't the only person with encephalopathy, that can go completely nuts when his ammonia levels are high. I'm not sure what the doctors think a psychiatrist can do for him. When he gets the first signs of high ammonia at home, even though I can't run labs on him, I give him extra lactulose. I've also found, as others have, that lower protein is the key for him. I try to explain this to the doctors, when I saw what they were feeding him this round in the hospital, but since I don't have MD after my name, I'm an idiot!

Grab a cup of coffee, and I'll give you his story. :) He was diagnosed with Hep C about 13 years ago. Failed Interferon treatments he was on for 1 year, and hadn't have any other treatment until around June this year. Like others I've been reading on this forum, my husband was a work-a-holic, high energy person that made my head spin! For years he dealt with edema in his legs and was treated with diuretics. He also had cirrhosis, when they did a biopsy when he was first diagnosed with Hep C.

My husband is an engineer for a huge company, and he works in cryptology. He also works part time as an event supervisor for the city. A job he works just out of sheer enjoyment. He's been on short term disability since Sept.23, this year, and I don't see him ever working again, unless he has a liver transplant.

In May of this year, he had a colonoscopy and endoscopy. That seemed to have started the ball rolling. I'm wondering if this had anything to do with it, but when I had these proceedures done last year, my doctor wouldn't let me use Fleet Bowel Prep, because he said since I'm diabetic, it's too much sodium, so he had me use Go-lytele. My husbands doctor gave him Fleet, so I called to make sure it was ok because of all the sodium, and they said it was fine. Well, about 3 weeks later, he'd swollen so much, he couldn't bend down to tie his shoes, and was short of breath. Took him to the doctor, then was sent to the ER to have a Parasentesis. They took off 6 litres. Was in the hospital a couple of days, felt better, then about 2 weeks after that, started throwing up fresh blood. Back to the hospital for banding of 4 varicies. Two weeks later, back in the hospital because he had dark blood in his stools, and throwing up dark blood. They said "someone dropped the ball and should have put him on Prilosec after the banding." While in the hospital, he started going downhill, not only was he in liver failure, but now he was in kidney failure. He was put in ICU because of low blood pressure and slipped into a 5 day coma because of not only his kidneys, but high ammonia levels. We live in Virginia Beach, and he was transferred by ambulance to VCU in Richmond to ICU. He was in restraints, because even though he was asleep, he responded to any stimulation like someone was trying to kill him. The liver transplant specialists, that we'd met with 2 months before, that told us he didn't qualify for a liver transplant talked to me, and told me his liver still wasn't bad enough for a transplant. He's still not even on the list! At that time, his MELD score was 26. His creatanine level was 4.8, and they got it down to 3.7 when they released him a week later. He spent his time in Richmond in the Hume Lee Transplant Center of the hospital, so I really thought maybe they'd walk in one day, and tell me he would be put on the list. NOT! They took him off all 3 diuretcs he'd been on, saying that was causing the kidney problems. The doctors here say he has hepatorenal syndrome. Doctors in Richmond disagree.

Thursday morning, my husband could barely breath, because of all the fluid buildup. It's always there, but gets to the point where the oxygen doesn't even help. They took off 3 liters, but said he had about 7 that needed drained, but the doc was afraid he'd go into shock. He did have some relief. They admitted him for "observation" but now it's Wednesday, and he was put in ICU yesterday. I could tell his ammonia levels have been going up since he got there. Blood test show it, but they wouldn't give him extra lactulose. I thought about taking some in from home, but figured they'd throw me in jail for giving him meds. I should have gone with my gut, and done it! The doctor told me my husband wasn't "complying" with taking his meds. Really? Makes sense to me, when a patient has high ammonia, won't take meds, and is difficult, to just let them slip into a coma. They're easier to deal with, I guess. I'm sick of doctors telling me that people with high ammonia levels, don't act like that. They think they only may get confused and sleep a lot. I feel like I'm dealing with morons. I've learned more on the internet. I did yell at one doctor, and told him to GOOGLE IT!! I'm sure they're about to restrain me in a bed!

I called the ICU nurse last night about 3am just to check on him. She said he wasn't any help when they were trying to change his bed. They're giving him lactulose through a nose tube, and he can't get up to go to the toilet because of his condition, but she's complaining because he wouldn't help turn himself over so they could clean him and change his bed. I swear I'm dealing with morons!

Yesterday, the nurse brought in a recliner to his ICU cube, and said I could stay as long as I wanted. Of course, I took care of him, so they wouldn't have to deal with him. I've always been told to keep ICU visits short. Anyway, I stayed all day. Everytime he woke up, he was confused and would start screaming, but you couldn't understand a word. I would pat his shoulder, tell him he was in the hospital and was getting better, and he'd be home soon. He'd go back to sleep.

Another episode of high ammonia with him was Oct. 11. We took him to the ER. He was being a total mean ass. They had a police officer standing by, so I called my sons in to play bouncer instead of having the cop to step in if he needed to. I'd rather have my sons man handle him. (BTW, my husband is 6ft 6, and 400lbs. I think at least 100lbs is fluid!.) They did labs, and his ammonia was 180. The ER doc said there was nothing else they could do for my husband, and I needed to have a "frank discussion" with his doctor. I went outside and called his doctor, but he was out of town, and talked to another doc in the practice that didn't know my husbands case. The next day, I spoke with his PCP, and he set him up on HOSPICE. I was just crushed! They were out and the nurse was trying to give my husband ativan and morphine. I told them if he took it, he'd go back into a coma and not be able to take the lactulose. Well, Hospice is there to help you die, so she didn't understand why I didn't want him to have the meds. Out of the blue, his gastro doc called and asked what in the world was going on at my house? He was in Chicago giving lectures. I told him what happened in the ER, that we were sent home, so he faxed me a note on his prescription pad that says if my husband is brought in to the ER, for hepatic encephalopathy, to admit him and treat him. How sad is that, that my family and I have to carry a permission note to take him to the hospital for treatment? He also said NOT to sign a DNR, because he'd never get a transplant. Hospice is now gone, because he was admitted to the hospital last week.

He's still not on the national transplant list. That's really all I want. I feel if his name is at least on it, there's hope.

Sorry for the long rant. I'm sure you've had to refill your coffee! :) I've got to get dressed and be the ICU nurse. Funny how I have to pay them so I can do their job.

BTW, my husband got hepatitis in the Navy, back in the 80's, but he doesn't remember what type. We've filed claims 3 times, hoping to find records of his 45 day treatment on the USS Eisenhower ship hospital, but each time we send for records, we're told, his medical file is empty! Sometimes there are just no breaks!

Everyone have the best day you possibly can.

Rebecca

hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 11/5/2008 12:32 PM (GMT -7)   

{{{{{{{{{{{Rebecca}}}}}}}}}}}  My heart really goes out to you.  You are certainly living in the midst of a nightmare.  It's a wonder you haven't "gone over the edge" by now. 

The ammonia level certainly is most likely responsible for your husband's behavior.  The cirrhosis causes the edema.  I've been on diuretics for close to 2 yrs. now, and expect to be for the rest of my life.  I was having a big problem with low potassium in the beginning, and found it difficult to take those huge potassium pills.  When I was put on Aldactone along with the Lasix, it balanced the potassium.  So no more fluid problems.  It doesn't sound as though your husband is getting the best care in Richmond, though I've heard good things about that hospital.  I know that the kidneys can also fail, but can't say why or if they are in your husband's case.

If it's any consolation, there are many spouses and caregivers here who are going through, or have gone through, similar trials with their loved ones.  I know that they can be a great support system for you, and also offer information.

I do know it is difficult to get placed on the transplant list.  They seem to go mostly by the MELD score.  Despite having chronic, active hep C (diagnosed in '93), cirrhosis and liver cancer, I was never considered for a transplant as my liver function has remained fairly good.  Go figure.

If it helps to vent, feel free to do so.  You have lots of company here, so welcome to the forum.
Hugs,
Connie
 
"But that was yesterday, and I was a different person then."
 
Alice in Wonderland, Lewis Carroll


Pink Grandma
Veteran Member


Date Joined Nov 2006
Total Posts : 2445
   Posted 11/5/2008 6:23 PM (GMT -7)   
Hello Rebecca and welcome to HealingWell. WOW!!!! You and your husband has been through the wringer with this. How in the heck can they not know how abusive and wild a liver patient who is suffering with encephalopathy can get is beyond me.

Thank God you had your sons to be body guards from the police. Most people don't understand what's going on with them. They don't know that they can not control themselves.
I had to call 911 once to get an ambulance for my husband to get him to the ER. He wouldn't let me and kept trying to hit me. The dispatcher asked me if he was combative and I had to tell her yes...........I wish now that I just had lied to her and said no. There was no less than 5 cop cars in front of my house when the ambulance finally came. I would not let the cops in my house. I was afraid that they would shoot my husband if he got combative. But when the paramedics talked to him he was as sweet as can be. And went peacefully with them. Go figure.

His GI doctor is the one who refers him to the transplant team. Has your husband's case ever been reviewed by the transplant team to make the list? If not find out why not. If they rejected him they should have sent you a letter. For them to even review my husband's case he had to lose 100 lbs. and be alcohol free for 6 months. 2 years later they finally reviewed him for transplant and denied him saying he still had to lose 30-35 lbs and go to AA meetings at least 25 times.

The hepatologist need to balance his meds. My husband was never taken off his diuretics. They would readjust the dosage as needed to keep his kidneys from failing. In fact it was a balancing act with all his meds. It got hard to keep track of all the changes they did. Never once did they have to drain my husband.

My thoughts and prayers will be with you and your husband.
Pink Grandma
Forum moderator-Hepatitis

When the going gets tough....the tough get going! Don't always know where I going but I get there anyways.


Butterflythree
Veteran Member


Date Joined Oct 2007
Total Posts : 954
   Posted 11/6/2008 4:38 PM (GMT -7)   
Rebecca, My heart goes out to you also. I am so sorry for all that you are going through. I don't understand how the doctors and nurses don't know that the ammonia levels are causing the episodes. My uncle died from cirrhosis many years ago. He was never a violent man and one of the sweetest people I have ever known. When he became very ill and his ammonia levels went up he became very violent. My husband has cirrhosis and hep C. He has frequent episodes of encephalopathy but it hasn't been bad enough that he has needed hospitalized. I have been very thankful for that. My prayers will be with you and you husband.
Butterflythree
 
There is always hope!


Mrs.O
New Member


Date Joined Nov 2008
Total Posts : 7
   Posted 11/7/2008 8:48 PM (GMT -7)   

Thank you all for sharing your information and experiences, and most of all your kindness. 

My husband was moved from ICU to the stepdown unit today.  The doctor told me his ammonia level was 112, so I was worried that maybe he'd had some type of brain damage or something, because I can barely understand a word he's saying.  I had the nurse print out his labs, and his ammonia is 164.  No wonder I can't understand him.  He's very calm though.  Probably because he's so weak.  They did put in another catheter in his neck to start dialysis tonight.  They'll give him dialysis tomorrow and then again on Sunday. 

His gastro doc said she'll call up to the transplant clinic in Richmond to see if she can get him on the list.  You never know. 

They've also started giving him high protein drinks for his kidneys.  I'm totally confused now!  He can't handle protein because of his liver, but he needs it for dialysis.  I'll certainly need to talk to a dietician about this. There has to be a balance somewhere.  I'll have to get info on hepatorenal syndrome.

Thanks again for all your help and good wishes.

Rebecca


hep93
Elite Member


Date Joined Jul 2005
Total Posts : 12014
   Posted 11/7/2008 10:14 PM (GMT -7)   
Rebecca, I worked for several years for a nephrologist (kidney specialist), and can tell you that it really is a balancing act in regard to dialysis.  They have to keep the electrolytes in balance in the "bath," as they call it, as well as weight.  To have both liver and kidney problems indeed will be a challenge to balance out everything.  I hope you can find some helpful information in your search for better understanding.

Hugs,
Connie
 
"But that was yesterday, and I was a different person then."
 
Alice in Wonderland, Lewis Carroll

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