In many cases, Valproic acid (Depakote) is prescribed for individuals who are suffering from seizures and some psychiatric disorders. In Mike’s case, his history of severe depression is warranted for the valproic acid. It should be noted that valproic acid can induce acute liver injury hence why his doctor probably ordered the liver function test.
With the result of the LFT showing extreme elevation in his AST and ALqT, there is strong evidence to suggest that Mike is suffering from liver damage, likely due to his prescribed medication. In the past, I have worked with patients who have elevated AST and ALT. in one particular case, my patient was suffering from acute liver damage due to a past medical history of chronic ETOH abuse. Hence, her diagnosis was alcoholic liver disease.
Hepatitis C is commonly transported through the blood, and this can be through childbirth, unprotected sex or through IV drug use. It can go from acute to chronic hepatitis which can be confirmed through several tests. One way is by conducting the recombinant immunoblot assay. If results are positive from this test, an additional test must be conducted to confirm the result. Another method of detecting the virus is through an HCV RNA test with PCR. This method can detect the virus as early as 2 weeks after infection.
In order to rule out alcohol as the likely cause of his elevated lab results of ALT and AST, the initial assessment asked him about alcohol use or the use of any other medication. Moreover, since Mike has admitted to using illicit IV drugs about 8 weeks ago, there is also a possibility that he may have contracted Hepatitis through needle use.
Research tells us that any individual on treatment with valproate should and must be assessed for liver function test as well as for hyperammonemia because early diagnosis and immediate withdrawal of valproate may result in clinical improvement of any drug-induced liver injury (Gayam et al., 2018). In their study, valproic acid was immediately stopped for the patient who was shown to exhibit clinical manifestation of drug-induced liver injury.
As a result, there was a rapid resolution and his laboratory levels went back to normal levels. For an individual diagnosed with acute hepatitis C, some common clinical manifestations that may be present include weakness, jaundice, nausea, right upper quad pain, malaise, followed by dark urine (Basit et al., 2022).
References:
Basit, H., Tyagi, I., & Koirala, J. (2022). Hepatitis C. In StatPearls. StatPearls Publishing.
Gayam, V., Mandal, A. K., Khalid, M., Shrestha, B., Garlapati, P., & Khalid, M. (2018). Valproic acid induced acute liver injury resulting in hepatic encephalopathy- a case report and literature review. Journal of Community Hospital Internal Medicine Perspectives, 8(5), 311–314. https://doi.org/10.1080/20009666.2018.151493
Order this paper