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How Can One Medically Address And Cure Acute Liver Injury Due To High Doses Of Drugs?
Question: Hello. I found out last night at the ER via US that my liver is measuring 19.4cm. I do not drink at all I don't do illegal drugs nor do I smoke weed. I do take Norco prn as well as xanax for panic attacks. Recently I have been taking extra Tylenol with the norco do to pain. I've been taking Norco for about 4 years now. I had a US about a yr ago do see if my gallbladder was acting up and everything was normal. The enlarged liver is brand new. I'm waiting to see a GI specialist to conduct more testing and I'm also cutting Norco and Tylenol out completely starting today (results were last night) I'm just curious as to what's going on. Considering my blood test we fine (alt was at 26) (ast was at 16) albumin was at 4.2, t-bili was at 0.3. My main question is with my cutting out The Tylenol and Norco and the fact I don't drink. Will My liver go back to normal size. Or is it going to continue to get worse? I sat down and started to really calculate it all out and the past 3 weeks I've been taking roughly 3500-4500mg of Tylenol a day.
Brief Answer:
Acute liver injury due to high doses of drugs.
Detailed Answer:
Hello and thanks for the query dear,
I've reviewed your attachments,
By ultrasound, a normal liver is less than 16 cm in the midclavicular line. As per the details provided by you and the reports attached your liver size is 19 plus. This is considered as mild hepatomegaly. Hydrocodone combined with acetaminophen causes acute liver injury.
Initially, as the cells of the liver are injured they start to die off. As a part of the protective phenomenon, the liver starts to regenerate new cells to overcome the loss caused by injury to the liver. In initial phases like yours, it's fully reversible and recoverable. In general, the recommended maximum daily dose of acetaminophen is no more than 4000 milligrams (mg) and you are already on more than maximum doses which is the cause of acute liver injury.
You have not mentioned the type of pain for which you are having this combination because you can substitute them with tramadol and low dose paracetamol combination.
This combination works best for pain and is very safe for liver and would help your liver to recover fast.
I would recommend you to lower the doses of acetaminophen and to add another relatively safe analgesic Tramadol 50 mg (prescription based medication) once or twice for pain.
Liver rejuvenator like milk thistle should be taken for a month to help liver overcome loses.
Follow a high carbohydrate and low fat diet.
Changes would reverse themselves in 3 month.
Though not a cause to panic as of now its just mild but if acute injury to liver continues then in long runs it could be harmful.
Hope I answered your query.
Regards.
Acute liver injury due to high doses of drugs.
Detailed Answer:
Hello and thanks for the query dear,
I've reviewed your attachments,
By ultrasound, a normal liver is less than 16 cm in the midclavicular line. As per the details provided by you and the reports attached your liver size is 19 plus. This is considered as mild hepatomegaly. Hydrocodone combined with acetaminophen causes acute liver injury.
Initially, as the cells of the liver are injured they start to die off. As a part of the protective phenomenon, the liver starts to regenerate new cells to overcome the loss caused by injury to the liver. In initial phases like yours, it's fully reversible and recoverable. In general, the recommended maximum daily dose of acetaminophen is no more than 4000 milligrams (mg) and you are already on more than maximum doses which is the cause of acute liver injury.
You have not mentioned the type of pain for which you are having this combination because you can substitute them with tramadol and low dose paracetamol combination.
This combination works best for pain and is very safe for liver and would help your liver to recover fast.
I would recommend you to lower the doses of acetaminophen and to add another relatively safe analgesic Tramadol 50 mg (prescription based medication) once or twice for pain.
Liver rejuvenator like milk thistle should be taken for a month to help liver overcome loses.
Follow a high carbohydrate and low fat diet.
Changes would reverse themselves in 3 month.
Though not a cause to panic as of now its just mild but if acute injury to liver continues then in long runs it could be harmful.
Hope I answered your query.
Regards.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you for your reply. The pain is more of a nagging throb. Along with occasional sharp pains. I have started milk thistle and vit. C. I have completely stopped all meds with any Tylenol. What confused me was my labs being perfect but having enlarged liver not due to fatty liver or alcohol. Also a yr ago my Cholesterol was at 211 and Triglycerides were at 250. I'm a 30yr old female 5'5 and 177. I'm curious how would a high carb diet help?
Brief Answer:
follow up.
Detailed Answer:
Hello again,
1)You can take tramadol in case you have pain.
Even Tylenol could also be taken but not more than 1000mg a day.
2)Carbs especially complex carbohydrate like oat barley brown bread etc are easy to digest. In easy language when you are sick we advise you to take rest in the same way when your liver is sick(easy language) you should take food which is easily digestible and on the other hand full of energy also. This will give rest to your injured liver and would hasten up the recovery. Complex carbs are best for recovery diet and should consist of minimum 60% of the diet.
3)You said you were non-alcoholic so there is no chance of alcohol-related injury.
However deranged lipids could be a cause but mild grade 1 fatty liver would be reflected in ultrasound.
In women levels of estrogen and progesterone could also cause such problem.
But you have a clear history of taking very high doses of drugs causing liver injury so primary factor should be eliminated first.
However, level of cholesterol and triglycerides should also be controlled.
As explained earlier during the initial phase of injury liver cell multiplies itself very fast and in an uncontrolled way hence compensating for dead cell so blood enzyme levels are not affected.
Secondly, enlargement is just mild and in initial stages many times enzyme levels are normal.
Level of enzymes ultrasound etc is different ways by which we predict the status of your liver. It's not necessary that every parameter is deranged if a particular report is not ok.
Hope I provided you the explanation in easy language.
Please feel free to follow up.
Regards.
follow up.
Detailed Answer:
Hello again,
1)You can take tramadol in case you have pain.
Even Tylenol could also be taken but not more than 1000mg a day.
2)Carbs especially complex carbohydrate like oat barley brown bread etc are easy to digest. In easy language when you are sick we advise you to take rest in the same way when your liver is sick(easy language) you should take food which is easily digestible and on the other hand full of energy also. This will give rest to your injured liver and would hasten up the recovery. Complex carbs are best for recovery diet and should consist of minimum 60% of the diet.
3)You said you were non-alcoholic so there is no chance of alcohol-related injury.
However deranged lipids could be a cause but mild grade 1 fatty liver would be reflected in ultrasound.
In women levels of estrogen and progesterone could also cause such problem.
But you have a clear history of taking very high doses of drugs causing liver injury so primary factor should be eliminated first.
However, level of cholesterol and triglycerides should also be controlled.
As explained earlier during the initial phase of injury liver cell multiplies itself very fast and in an uncontrolled way hence compensating for dead cell so blood enzyme levels are not affected.
Secondly, enlargement is just mild and in initial stages many times enzyme levels are normal.
Level of enzymes ultrasound etc is different ways by which we predict the status of your liver. It's not necessary that every parameter is deranged if a particular report is not ok.
Hope I provided you the explanation in easy language.
Please feel free to follow up.
Regards.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Okay.. thank you for your information. in you professional opinion because my levels are good isn't safe to say as long as I cut off the damaging stuff my liver should be okay and I won't suffer any permanent damage such as Cirrhosis
Brief Answer:
follow up.
Detailed Answer:
Hello my dear,
Cirrhosis takes minimum of 5 to 10 years to develop and that too in patients who are abusing alcohol and drugs.
There are 4 grades of fatty liver and if the patient remains untreated then he/she lands up in cirrhosis.
Don't worry at all.
Just follow what I suggested and your liver would be back to normal in 3 months.
Less then 16 cm size is a 95th percentile which means that in a selected study group, for example, 10000 people size of the liver in 95% was about 16 cm so it's taken as normal size for the theoretical purpose, however, a variation can be there. It's not necessary that 1 or 2 cms more always reflects a pathology rather patient can be among rest 5% population. Just because you were on a high dose of medicines we consider you a case of acute liver injury but there is a possibility that your liver is perfectly normal(liver enzymes are not raised).
So hope you would feel relaxed after the explanations I gave you.
Please feel free to follow up.
Wish you a good day ahead.
follow up.
Detailed Answer:
Hello my dear,
Cirrhosis takes minimum of 5 to 10 years to develop and that too in patients who are abusing alcohol and drugs.
There are 4 grades of fatty liver and if the patient remains untreated then he/she lands up in cirrhosis.
Don't worry at all.
Just follow what I suggested and your liver would be back to normal in 3 months.
Less then 16 cm size is a 95th percentile which means that in a selected study group, for example, 10000 people size of the liver in 95% was about 16 cm so it's taken as normal size for the theoretical purpose, however, a variation can be there. It's not necessary that 1 or 2 cms more always reflects a pathology rather patient can be among rest 5% population. Just because you were on a high dose of medicines we consider you a case of acute liver injury but there is a possibility that your liver is perfectly normal(liver enzymes are not raised).
So hope you would feel relaxed after the explanations I gave you.
Please feel free to follow up.
Wish you a good day ahead.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Thank you so. mkuch. Th at makes me feel so much better. I have an appt with GI soon. And have labs I'm doing on Wednesday to check fasting levels. I have not taken pain pill since this has happened along with stopped smoking and tryin to eat better. If anything this was blessing in disguise. Thank you for your help
Brief Answer:
Get well soon.
Detailed Answer:
Wish you a good life ahead.
Do rate the answer.
Regards!
Get well soon.
Detailed Answer:
Wish you a good life ahead.
Do rate the answer.
Regards!
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Above answer was peer-reviewed by :
Dr. Raju A.T
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