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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have Pain Due To End Stage Liver Disease. Prescribed Cymbalta. Have Seizures. Your Opinion?

My dad is end stage liver desease and was in the hospital for over medicating himself. He has chronic pain and see a pain mangment doctor. He hate more than a safe amount of different prescriptions and ended up in the er. 5 days later in the hospital. The doctor prescribes him cymbalta( at this time he was looking fine. Ammonia levels were about 60 and could walk and talk just fine.) They gave him a dose and than after he told us we told him not to take it. Knowing it is highly toxic to the liver. A day later he is having seizures about 4 of them and now is constantly moving his hands and is rambling ridiculous things. Just wondering your opnion on this situation.
Mon, 23 Sep 2013
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Gastroenterologist,  's  Response
Hello! Thanks for putting your query in HCM. I am a Gastroenterologist (DM).

I appreciate your concern regarding your father. It seem that your father is having hepatic encephalopathy.

There are many reasons for it in patients of end stage liver disease:
1. Take antidepressants and sedative. In his case may be overdose of cymbalta. So avoid them
2. Dyselectrolytemia so check his electrolytes like serum sodium, and potassium levels and do correct them
3. Constipation: Avoid constipation by giving him syrup lactulose and titrate it's dose to make 2-3 stools/ day
4. Any infection: Check his WBC and if it is elevated give him antibiotics
5. Any GI bleed: see his stool color if it is black then he needs urgent endoscopy examination and endotherapy
6. Root cause of ESLD to be found out and should be treated accordingly like hepatitis B and Hepatitis C
7. Anemia: Requires blood transfusion

I think he should be hospitalized as soon as possible as he is also having seizure

I hope I have answered your query and this will help you. If you have any further query I will be happy to answer that too. Remain in touch and get-well soon.
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Have Pain Due To End Stage Liver Disease. Prescribed Cymbalta. Have Seizures. Your Opinion?

Hello! Thanks for putting your query in HCM. I am a Gastroenterologist (DM). I appreciate your concern regarding your father. It seem that your father is having hepatic encephalopathy. There are many reasons for it in patients of end stage liver disease: 1. Take antidepressants and sedative. In his case may be overdose of cymbalta. So avoid them 2. Dyselectrolytemia so check his electrolytes like serum sodium, and potassium levels and do correct them 3. Constipation: Avoid constipation by giving him syrup lactulose and titrate it s dose to make 2-3 stools/ day 4. Any infection: Check his WBC and if it is elevated give him antibiotics 5. Any GI bleed: see his stool color if it is black then he needs urgent endoscopy examination and endotherapy 6. Root cause of ESLD to be found out and should be treated accordingly like hepatitis B and Hepatitis C 7. Anemia: Requires blood transfusion I think he should be hospitalized as soon as possible as he is also having seizure I hope I have answered your query and this will help you. If you have any further query I will be happy to answer that too. Remain in touch and get-well soon.