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Suffering from cirrhosis, diabetes and hepatitis C. Had heart surgery. Transjugular intrahepatic portsystemic shunt placed in the liver. Uncontrolled sugar levels. Why?

My mother in law suffers from cirrhosis of the liver, she s had a transjugular intrahepatic portsystemic shunt placed in her liver in early 2010 due to portal hypertension . She s Hep C positive and interferon treatments were unsuccessful, twice. Also in 2010 she had heart surgury on her main coronal artery with 85% blockage with subsequent plural effusion . She has diabetes mellitus 2. She s also on Xifaxin and 45mL of Lactulose 4 times a day. Her platelets are under 35k with reaccuring spontaneous bacterial peritonitis, hepatic encephelopathy and various other ailments. Her Meld score is currently 20. Overall, my question is this. After 3 weeks of elevated blood glucose levels which are consistently between 400-550 during any random and fasting readings, and trips to the ER 2 days consecutively, I feel that they are not sure exactly what s going on, but ever since this started 3 weekes ago after a severe UTI, a week stay in the hospital and an Albumin theraphy, I feel as if they are not telling us something. She s gone from 10 units of Novolin with great results over the past two years, to over 100 units daily of humilin R and lantus while her glucose is still skyrocketing. I ve also noticed signs of ketoacidosis, but that s from only internet research so I might be looking too far into it. Any thoughts are appreciated! Mike
Asked On : Fri, 31 Aug 2012
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Anesthesiologist 's  Response

Noted the clinical prcoeedings.

Hep C with liver cirrhosis with recurring SBP and encephalopathy,low platelets
with signs of ketoacidosis indicates that she is in the decompensated phase of end stage liver disease.

MELD of 20 which signifies that she has to undergo a liver transplant shortly.

The primary problem here is the Liver.

She has to be admitted to an intensive care unit.
First her hemodynamics has to be stabilised.
Infection controlled with appropriate broad spectrum antibiotic.
Ketoacidosis if untreated could be life threatening.
Low platelets corrected.
Cardiac condition optimised - have an echo,ecg done and cardiac mediations taken.
Metabolic parameters corrected if there is any abnormality and Renal function monitored.
Answered: Fri, 31 Aug 2012
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