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brothers latest lab numbers........not good

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Posted 4/23/2014 5:46 PM (GMT 0)
On Monday my brothers Dr called me, his kidney function had gotten worse. 3 Dr's involved all think the liver AND kidneys will fail and there is not much more they can do. The only other thought was to move him to another hospital that has a liver team etc. Our family convinced my brother to do that and he was moved there last night. I'm awaiting a call from the dr's there today.

Here is what worries me, his lab results, maybe someone with more knowledge on the kidney issue with ESLD can offer some support?
Yesterday they couldn't drain his abdomen because of how high his INR was.
Here are the numbers I know between Monday and yesterday:

BUN 40 up from 32 yesterday
INR 2.77 up from 2.3
Creatinine 2.77 up from 2.3
Bilirubin 33 up from 27
Albumin 2.3
Potassium 3.4
ALT 58
Protein 5.3
Platelet 135

I have other test result numbers if those are helpful. I just spoke with him on the phone and he is confused and seeing things. The nurse said they are giving him lactulose. He says he can feel that something isn't right. He's getting agitated and it's scaring me. I'm worried at how fast hist lab numbers are raising. His MELD computes at 41 right now!! How bad are the kidneys with those creatinine and BUN numbers? I'm still waiting for his dr to call me. I know you guys can't tell me what will happen. But I just keep thinking this is going downhill FAST and I'm worried a coma may happen sooner than later..........
Posted 4/23/2014 7:29 PM (GMT 0)
You have the same number for INR and Creat. If this is not a typo, I show a MELD 40. Since he is not on a transplant list, it looks grim, Cat. Sorry things are so discouraging. Big Hugs,
Posted 4/23/2014 8:17 PM (GMT 0)
I know, that was not a typo.....it is the same number. He cannot get on a transplant list, because he does not have 6 months sobriety. I guess I'm now wondering how fast or long this will go??? I know no one can answer that for me.
Posted 4/23/2014 8:41 PM (GMT 0)
You're right. No one knows. You have watched this for years, and it is such a difficult thing to go through for your family. Hang in there. Big Hugs, Cat
Posted 4/24/2014 3:57 AM (GMT 0)
Hi CG. First...I am so sorry that your brother is so ill. This must be incredibly difficult for you. And I know how hard it is to want (need) answers so badly and not be able to get them. Liver disease is so unpredictable and that makes it very hard, not just on the patient, but the caregivers and loved ones too.

I'm so sorry, but like themiz said, his situation doesn't look great. Now that's not to say it's impossible for things to turn around - as long as there's breath, there's hope - but those are some pretty high numbers. His INR would have to decrease to at least 1.5 before they would attempt paracentesis His BUN is twice the high end of normal range and his Creatnine is double normal levels. Do you know what his GFR is? This shows how well the kidneys are processing waste. This test is a bit different than most - the higher the number, the better - anything lower than about 15ml/min means that dialysis or transplant is needed. Normal is 90 or higher.

Your brother's agitation, confusion, and hallucinations could be from his failing kidneys, not just from high ammonia levels. What is his ammonia level? There is something called 'metabolic acidosis', that occurs when the kidneys are not removing enough acid from the body (or when the body is producing too much). Do you know what his pH level is?

I honestly don't want to upset you with the info I've given you - I only wanted to answer your questions. I'm a research fanatic and did tons of it during Robert's illnesses. I'm the kind of person who doesn't like being in the dark about things - I'd rather know what I'm facing because it helps me to deal. Your brother (and you) will be in my thoughts and prayers. Hang in there. And keep talking with your brother. He may or may not fall into a coma - there's just no way of telling right now. If I had only known what was going to happen to Robert, I would have talked his ear off (and listened) in the days before his coma. By telling you that, I'm hoping that just in case, you can benefit from my mistake. Thinking of you.....

Post Edited (Splashdancer) : 4/23/2014 10:02:46 PM (GMT-6)

Posted 4/24/2014 9:15 PM (GMT 0)
I don't know what his GFR was yesterday. I know last week it ranged from mid 30's to mid 40's . The hospital he's at is about an hour drive for me so it's hard to get there. I'm going tonight to see him though. I call him everyday multiple times a day to check on him and his Dr will be calling me daily with updates and plan of care. His sodium went up a little bit to 126 so that's a slight improvement. The Rifaximine is helping his HE. Today his INR is 2.6, Creatinine went up to 3.03, Billirubin 27.5 (down a tad bit). They are still withholding the lactulose. He got an ultrasound of his liver and kidneys today and we'll get those results tomorrow. The Dr said it's too soon to tell if the kidneys are stabilizing but he feels any SLIGHT improvement is a small victory right now.
I'm not sure what his ammonia levels are. Nor do I know his pH level but I can certainly find out.
Splashdancer, you are NOT upseting me at all. I want the info, I feel I NEED to know as much as I can to understand all that is happening. I have researched this disease for over a decade now. Like you said, it helps me deal also.
I worry about the coma thing. He's slept a lot the past 2 days which kind of worries me . Not sure if he's just tired or if it's a bad sign that he's sleeping so much.
Posted 4/28/2014 1:18 PM (GMT 0)
Hi Catgirl,
How is your brother doing? Please update us and let us know . I hope that all is going well.

WD
Posted 4/28/2014 1:40 PM (GMT 0)
He's still in the hospital. They are weaning him off the 3 meds for the kidney issues to see if his kidneys will "hold their own". They were trying to determine if the kidney problems were from dehydration or the liver failure. The kidneys are getting better from those meds.
Current labs from the weekend:
Saturdays numbers:
MELD 37
Hemoglobin 8.6
Creatinine 2.13
INR 2.7
Platelets 88
BUN 41
Bilirubin 28.2
ALT 37 (normal)
AST 95 high

Yesterday's numbers that the nurse have me on the phone, I didn't talk to the dr yesterday:
MELD 34
Bilirubin 18
INR 2.7
Creatinine 1.8

The MELD I've been calculating myself. That's gone down a little from earlier in the week but the INR isn't changing. He's getting vitamin K and potassium still. They were giving him octreotide and albumin. His girlfriend said yesterday his ankles look swollen, he stil has a lot of acsites in his abdomen that they can't drain right now. He now has a fungal infection that they're treating. Not sure if it's a UTI (not sure how serious that it with cirrhosis). They took him off the cathedar. He's alert, in good spirits and has no pain and is eating so that's good. I can not tell you how much I hate this roller coaster of this disease. At this point I don't know how long he'll be in the hospital.
Posted 4/28/2014 4:24 PM (GMT 0)
Hi Cat, You must be exhausted. Take care of you. Glad to hear your brother is feeling some better. Big Hugs,
Posted 4/28/2014 7:29 PM (GMT 0)
The roller coaster ride of liver disease...all you can hope for some days is that it slows down a bit...it is tough to get the ringmaster to stop the darn thing to let you off! Hugs, ML
Posted 4/29/2014 4:29 PM (GMT 0)
That fungal disease is very dangerous!!
Posted 4/29/2014 5:58 PM (GMT 0)
It is??? The Dr's aren't acting as it is. They're treating him with antibiotics, but talking about maybe releasing him to a LTAC in the next couple days....
Posted 4/30/2014 12:58 AM (GMT 0)
with a decompensated system.. any infection is dangerous..
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