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Can Vitamin B12 Deficiency Cause Hepatitis?
Question: hello doctor (30 years, male), i am suffering from medicinal lymphadenopathy of right paracial lymph node ,biopsy confirm tb , sensitivity report resistant to ofloxacin and moxifloxacin since last month.doctor advised me to take Isoniazide (H), Rifampicin (R), ethambutol (E) and Pyrazinamide (Z) separately for 8 days and then akurit-4, thereafter but after using it for 16 days i was effected with drug induced hepatitis (vomiting etc., sgpt 166, sopt 76) . Further my vitamin b12 level was 194 and vitamin D3 level was 8 only. doctor has said me to stop the medicine, so i stop it for 10 days .now they advised me to take combutol-1000 along with streptomycin injections(750ml) per day. my sgpt level reduced to 66 and sopt 43).
my questions are
1. does the hepatitis it due to vitamins (b12 or d3) deficiency. i have all other liver test, all negative.
2. only two medicine (combutol-1000 along with streptomycin injections(750ml) per day) is enough, doctors have said me to reintroduce the other drugs after some time.
3. what are the chance does i have already got any drug resistance. (had stopped ATT for 10 days in between with doctors advice)
4. does introduction of same drug again leads to same problem of hepatitis.
my questions are
1. does the hepatitis it due to vitamins (b12 or d3) deficiency. i have all other liver test, all negative.
2. only two medicine (combutol-1000 along with streptomycin injections(750ml) per day) is enough, doctors have said me to reintroduce the other drugs after some time.
3. what are the chance does i have already got any drug resistance. (had stopped ATT for 10 days in between with doctors advice)
4. does introduction of same drug again leads to same problem of hepatitis.
Brief Answer:
No, these deficiencies can not cause hepatitis.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Answer to your 1st question.
No, vitamin B12 and vitamin D3 deficiency can not cause hepatitis. Your hepatitis is due to rifampicin, isoniazid and pyrazinamide. It is called drug induced hepatitis.
Answer to your 2nd question.
To answer this question, I need your detailed sensitivity report.
You said that ofloxacin and moxifloxacin are resistant. What about sensitivity of first line drugs like ethambutol, streptomycin, isoniazid, pyrazinamide and rifampicin?
Answer to your 3 rd question.
No need to worry for drug resistance in 10 days of treatment stoppage. This is the reason I want to know your detailed sensitivity report.
Answer to your 4th question.
Introduction of rifampicin, isoniazid and pyrazinamide in gradual manner will not cause hepatitis again in most of the cases.
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wish you good health. Thanks.
No, these deficiencies can not cause hepatitis.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Answer to your 1st question.
No, vitamin B12 and vitamin D3 deficiency can not cause hepatitis. Your hepatitis is due to rifampicin, isoniazid and pyrazinamide. It is called drug induced hepatitis.
Answer to your 2nd question.
To answer this question, I need your detailed sensitivity report.
You said that ofloxacin and moxifloxacin are resistant. What about sensitivity of first line drugs like ethambutol, streptomycin, isoniazid, pyrazinamide and rifampicin?
Answer to your 3 rd question.
No need to worry for drug resistance in 10 days of treatment stoppage. This is the reason I want to know your detailed sensitivity report.
Answer to your 4th question.
Introduction of rifampicin, isoniazid and pyrazinamide in gradual manner will not cause hepatitis again in most of the cases.
Please reply me answers of above asked questions, so that I can guide you better.
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
sir,
i have uploaded my sensitivity report.
sensitivity report does not suggest any resistance towards any first line drugs like ethambutol, streptomycin, isoniazid, pyrazinamide and rifampicin.
but since due to these first line drugs except streptomycin, which i took leads to hepatitis in my case.
i have started ethambutol(1000 mg), isoniazid(300 mg) , pyrazinamide(1500 mg) and rifampicin (450 mg) daily since 30/03/2016 separately for 8 days , then akurit 4 ,4 tablets daily till 16/04/2016, then i stopped all medicine due to vomiting and sgpt 166, and sopt 76 with doctors advice. i had done LFT after 5 days sgpt 99, sopt 61 , then again after 5 days sgpt 66, and sopt 43 (no medicine in between these 5+5=10 days), then only two medicine (combutol-1000 along with streptomycin injections(750ml) per day) as ofloxacin and moxifloxacin are resistant (plz see my sensitivity reports).
doctors said the you that to take these injections upto 2 months, then again they will review my progress.
i am afraid that whether quitting medication (in between those 10 days) had already leads to more drugs resistance? because i my taking (combutol-1000 along with streptomycin injections(750ml) per day) since 29/04/2016 till date but my cough is increasing. i am my able to understand whether this is normal cough to due to tb? i had cough and cold in between these days, cold vanishes but cough continue, i do running everyday's , had coconut water, and curd rice daily in morning before taking injections
HIV test is non reactive,
further all test for other liver disease turns negative.
i am undergoing treatment in sevenhills hospital XXXXXXX with doctors XXXXXXX panjwani, and for liver doctor c. XXXXXXX
they are treating me but not telling me further course of action.
that's why need help?
not sure what is going to happen? plz help
i have uploaded my sensitivity report.
sensitivity report does not suggest any resistance towards any first line drugs like ethambutol, streptomycin, isoniazid, pyrazinamide and rifampicin.
but since due to these first line drugs except streptomycin, which i took leads to hepatitis in my case.
i have started ethambutol(1000 mg), isoniazid(300 mg) , pyrazinamide(1500 mg) and rifampicin (450 mg) daily since 30/03/2016 separately for 8 days , then akurit 4 ,4 tablets daily till 16/04/2016, then i stopped all medicine due to vomiting and sgpt 166, and sopt 76 with doctors advice. i had done LFT after 5 days sgpt 99, sopt 61 , then again after 5 days sgpt 66, and sopt 43 (no medicine in between these 5+5=10 days), then only two medicine (combutol-1000 along with streptomycin injections(750ml) per day) as ofloxacin and moxifloxacin are resistant (plz see my sensitivity reports).
doctors said the you that to take these injections upto 2 months, then again they will review my progress.
i am afraid that whether quitting medication (in between those 10 days) had already leads to more drugs resistance? because i my taking (combutol-1000 along with streptomycin injections(750ml) per day) since 29/04/2016 till date but my cough is increasing. i am my able to understand whether this is normal cough to due to tb? i had cough and cold in between these days, cold vanishes but cough continue, i do running everyday's , had coconut water, and curd rice daily in morning before taking injections
HIV test is non reactive,
further all test for other liver disease turns negative.
i am undergoing treatment in sevenhills hospital XXXXXXX with doctors XXXXXXX panjwani, and for liver doctor c. XXXXXXX
they are treating me but not telling me further course of action.
that's why need help?
not sure what is going to happen? plz help
Brief Answer:
Continue with ethambutol and streptomycin injections.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
I have gone through the sensitivity report you have attached.
No need to worry much.
Take ethambutol and streptomycin injections daily.
You can add first isoniazid. Take all three drugs fir 7-10 days. Get done SGPT. If normal then add rifampicin. Take four drugs for 7-10 days and get done SGPT again. If normal then add pyrazinamide. Get done SGPT after 7-10 days, if normal then you can take all drugs for total 2-3 months and then three drugs for 5 months.
Please let me know if you are drinking alcohol or smoking cigarettes.
I will be happy to help you further. Wish you good health. Thanks.
Continue with ethambutol and streptomycin injections.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
I have gone through the sensitivity report you have attached.
No need to worry much.
Take ethambutol and streptomycin injections daily.
You can add first isoniazid. Take all three drugs fir 7-10 days. Get done SGPT. If normal then add rifampicin. Take four drugs for 7-10 days and get done SGPT again. If normal then add pyrazinamide. Get done SGPT after 7-10 days, if normal then you can take all drugs for total 2-3 months and then three drugs for 5 months.
Please let me know if you are drinking alcohol or smoking cigarettes.
I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you sir for your answer, i am feeling much better now.
No, i am not taking drinks or smoking,
since i live alone here in XXXXXXX hence adequate diet may be a problem,
Further i want to know does is it better to follow WHO schedule (2 months of intense phase (four medicine 3 times a week) and (4 months of continuation phase (2 medicine (3 times a week)) ?
may be daily schedule again leads to hepatis?
approx how many days of discontinuation leads to drug resistance? (i am little concern here sorry for asking again).
No, i am not taking drinks or smoking,
since i live alone here in XXXXXXX hence adequate diet may be a problem,
Further i want to know does is it better to follow WHO schedule (2 months of intense phase (four medicine 3 times a week) and (4 months of continuation phase (2 medicine (3 times a week)) ?
may be daily schedule again leads to hepatis?
approx how many days of discontinuation leads to drug resistance? (i am little concern here sorry for asking again).
Brief Answer:
Daily treatment is better than intermittent treatment.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Daily treatment is better than intermittent treatment.
So better to take daily treatment instead of WHO schedule.
It is having higher cure rate and gives quick relief.
Incidence of hepatitis is same in both treatment.
Actually hepatitis is more common when
1. Previous history of liver disease
2. Also taking other hepatotoxic drugs like painkiller drugs.
Please let me know if you are having any of these factors in your case.
And when you not take anti tubercular drugs for consecutive 2 months, then chances of drug resistance is more.
Please let me know about above things, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.
Daily treatment is better than intermittent treatment.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Daily treatment is better than intermittent treatment.
So better to take daily treatment instead of WHO schedule.
It is having higher cure rate and gives quick relief.
Incidence of hepatitis is same in both treatment.
Actually hepatitis is more common when
1. Previous history of liver disease
2. Also taking other hepatotoxic drugs like painkiller drugs.
Please let me know if you are having any of these factors in your case.
And when you not take anti tubercular drugs for consecutive 2 months, then chances of drug resistance is more.
Please let me know about above things, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear sir,
thanks you for the answer,
No, i don't have any of these factors, no history of liver disease, plus though i have upper back pain since 14 years (should blade) i usually do not take painkiller , in fact when my back pain increase then after MRI/CT/biopsy/culture all these things started, hepatitis and all
after taking 9 days of ethambutol and streptomycin injections, i have not improved my conditions, pain is increasing and cough still present, my doctors advice me to continue ethambutol and streptomycin injections for 2 months ,
then they will review the progress,
taking only two medicine is effective?
what if reintroducing isoniazid, rifampicin, pyrazinamide again leads to hepatitis?
is resistance issue is still there?
I am very thank to you sir, you have cleared lots of my doubts.
thank you very much
waiting for your reply,
thanks you for the answer,
No, i don't have any of these factors, no history of liver disease, plus though i have upper back pain since 14 years (should blade) i usually do not take painkiller , in fact when my back pain increase then after MRI/CT/biopsy/culture all these things started, hepatitis and all
after taking 9 days of ethambutol and streptomycin injections, i have not improved my conditions, pain is increasing and cough still present, my doctors advice me to continue ethambutol and streptomycin injections for 2 months ,
then they will review the progress,
taking only two medicine is effective?
what if reintroducing isoniazid, rifampicin, pyrazinamide again leads to hepatitis?
is resistance issue is still there?
I am very thank to you sir, you have cleared lots of my doubts.
thank you very much
waiting for your reply,
Brief Answer:
What is your weight?
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
In my opinion, you should ask for reintroduction of isoniazid, pyrazinamide and rifampicin.
These three are main drugs for tuberculosis especially in initial months of treatment.
And this is not standard practice to give only ethambutol and streptomycin in AKT induced jaundice.
You should definitely give trial of reintroduction.
In fact, taking only ethambutol and streptomycin may develop drug resistance and delayed recovery.
And I have seen many patients who do not develop hepatitis on reintroduction if these hepatotoxic drugs.
Since you are so much concerned about drug resistance, please let me know your weight because under or over dosing of anti TB drugs can also lead to drug resistance.
So please let me know
1. Your weight
2. When did you last consulted your doctor? Is he not in favour of reintroduction? If so then why?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.
What is your weight?
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
In my opinion, you should ask for reintroduction of isoniazid, pyrazinamide and rifampicin.
These three are main drugs for tuberculosis especially in initial months of treatment.
And this is not standard practice to give only ethambutol and streptomycin in AKT induced jaundice.
You should definitely give trial of reintroduction.
In fact, taking only ethambutol and streptomycin may develop drug resistance and delayed recovery.
And I have seen many patients who do not develop hepatitis on reintroduction if these hepatotoxic drugs.
Since you are so much concerned about drug resistance, please let me know your weight because under or over dosing of anti TB drugs can also lead to drug resistance.
So please let me know
1. Your weight
2. When did you last consulted your doctor? Is he not in favour of reintroduction? If so then why?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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