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Discussion on Antibiotics affecting liver values?
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New Member:
cayman
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Posted on Tuesday, Aug 3, 2010 - 9:10 pm:
Hi Dr. O.,
My 26 year old gelding was hospitalized for two weeks due to an especially bad case of aspiration pneumonia following choke. He wasn't expected to live, but he did. His liver values were normal as of a week ago. They ran the labs again the day before he was discharged and his SDH, GGT, AST and T-Bilirubin were high. By this time he had been on three antibiotics for almost a week and a half. His appetite has been poor since coming home. He was on Cefazolin, Enrofloxacin and Metronidazole. Is it possible that the antibiotics are causing his liver values to be so high? And if so, would you discontinue the antibiotics?
Thank you,
Mary
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Moderator:
DrO
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Posted on Saturday, Aug 7, 2010 - 8:10 am:
Hello Mary,
Yes drugs can cause liver enzyme elevation but not usually a rise in bilirubin....unless they also caused a bit of hemolysis which is reported with penicillin or which cefazolin is distantly related. You should not make the decision to continue or discontinue an antibiotic based on what is possible. The infection must be addressed also.
If there is ongoing concern about the liver it should be worked up as described in the article. What were the values Mary, including the units and normals? To evaluate the possibility of hemolysis we also need a hematocrit and hemoglobin reading.
DrO
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New Member:
cayman
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Posted on Saturday, Aug 7, 2010 - 9:13 am:
Hi Dr. O.
His SDH is 134 (normal is 0-12IU /L)
His GGT is 332 (normal is 7-20 IU/L)
His AST is 2313 (normal is 199-400 IU/L)
His Total bilirubin is 4.7 (normal is 0.5-1.7 MG/DL)
His hemoglobin is 19.8 (normal is 11.0-16.0 g/dl)
His hematocrit is 55 (normal is 31-47%)
He also received a plasma transfusion while in the hospital. Is it possible that could be contributing to his liver disease? His liver values were normal upon admission.
Thank you,
Mary
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Moderator:
DrO
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Posted on Sunday, Aug 8, 2010 - 7:15 am:
Plasma transfusions can be associated with transient liver reactions as the liver filters out foreign proteins, chronic liver disease if a autoimmune reaction sets up, and cause hemolysis if foreign antibodies attack the RBC's. You do have a suggestion of mild hemolysis as shown by the increased ratio of hemoglobin concentration to hematocrit.
DrO
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New Member:
cayman
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Posted on Sunday, Aug 8, 2010 - 9:03 am:
Dr.O.,
What would your recommendation be for treatment if this is what is going on?
Thanks,
Mary
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Moderator:
DrO
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Posted on Tuesday, Aug 10, 2010 - 2:20 pm:
Mary you first need to diagnose what is going on in anything other than recovering from the previous illness, before you consider treatment. The article discusses this.
DrO
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Member:
cayman
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Posted on Tuesday, Aug 10, 2010 - 2:39 pm:
Dr. O.,
Well he appears to be getting better every day. We have drawn blood to recheck his CBC and liver values and are awaiting results. He is currently off all antibiotics and is receiving Gastrogard for an ulcer, Equioxx, and Milk Thistle for his liver. His appetite is improving every day. In the meantime I will read over the article.
Thanks,
Mary
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Member:
cayman
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Posted on Thursday, Aug 12, 2010 - 12:25 pm:
Hi Dr. O.,
His SDH has gone from 134 to 20. His GGT is still elevated, AST has decreased as well. PCV is 47. His appetite is still not back to normal, but he is eating. How long can it take for a horse to recover from a severe case of aspiration pneumonia? He also had significant pulmonary edema.
Thanks,
Mary
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Member:
mrose
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Posted on Thursday, Aug 12, 2010 - 7:35 pm:
Hi Mary; obviously I'm no vet, but we had a 5 mo. foal that took 6 weeks to recover fully from aspiration pneumonia. I assume it depends on seriousness of the pnuemonia and how early it's detected as well as on the age of the horse.
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Member:
cayman
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Posted on Friday, Aug 13, 2010 - 1:36 am:
Thanks Sara. He had a very bad case and he is 26 so I am guessing that recovery will be a fairly slow process. It helps to hear of other's experiences.
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Moderator:
DrO
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Posted on Saturday, Aug 14, 2010 - 7:33 am:
The time for recovery will vary, mary depending on many factors. You should look for continuing improvement.
DrO
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