Thanks for your query at DoctorSpring.com
I understand your concern
Your white cell count is high which is due to the infection you had. White cell count increases when you get infection.
Some of the parameters in your blood gas report is out of range. But it has to be correlated with the clinical findings. Since you are feeling better, those things can be ignored.
Your liver function test apppears deranged. The AST and ALT are significantly high. Further evaluation is needed. The probable causes are viral infection, autoimmune and metabolic diseases, fatty liver disease and drug induced liver injury.
Consult a hepatologist for further evaluation.
I hope that answers your query.
Let me know if I can assist you further.
Patient replied :
Thanks. I'm better on the fever front but I pretty much always have significant GI issues, but it's always been assumed to be the combination of gastroparesis and antidepressants. My liver enzymes have been slightly elevated before, but nothing nearly this high (before it was just about 5 points too high), but they're usually normal (they were normal 6 weeks ago, slightly elevated 6 months ago). Would I have to worry about fatty liver disease if I'm a normal weight, don't drink much, and eat healthily (when I eat... low appetite)? (While 135lbs, I'm routinely told I look more like 120, but I'm really athletic and have a lot of muscle weight). I had a few overdoses in the last couple of years (a bottle of Tylenol with a bottle of Valium in 2013, a bottle of Valium with a few drinks in 2014, a bottle of Klonopin with a few drinks at the beginning of the year), though none in the last few months and since then I've had normal liver enzymes readings in a couple separate blood tests, most recently when I was in the ER for electrolyte issues in mid-April and I've been really responsible since then with respect to managing mood, meds, food and booze, exercise, etc. but I wasn't sure how much these completely anomolous (for me) results could have anything to do with my earlier acts with respect to my severe depressive episodes.
Sometimes the raise in liver enzymes could be due to insignificant causes and also difficult to know what is causing it.
I do not think this could be a result of your earlier acts.
As advised earlier you can get tested for the common causes like viral infections, autoimmune and metabolic diseases.
You can repeat the liver function test after 4 weeks.
Patient replied :
Thanks. Hypothetically if it is a metabolic or autoimmune issue (I already have two autoimmune conditions...), would it produce consistently abnormal liver enzyme tests, or could they fluctuate from normal and abnormal?
Metabolic can fluctuate whereas autoimmune is always consistent with abnormal liver enzymes.
Patient replied :
In looking at metabolic liver issues, I'm wondering whether Wilson's Disease is something that would have come up in normal batteries of test (CBC, metabolic panel, and whatever panel of tests it is that looks at protein, AST, ALT, bilirubin, etc.) such that it shouldn't be a concern, or is it something to ask my primary doc about given these results? (I know it's rare and I don't want to be hypochondriacal, but I have a lot of the symptoms listed -- tremor, depression, low blood sugar, fatigue, lack of appetite, muscle stiffness, bruising easily, etc. -- which of course I know can also be associated with other more minor things (with a history of anemia, the bruising and fatigue makes sense, with the calcium issues the muscle tension and cramps make sense, etc.). But since I do have so many of the symptoms, it seemed worth asking.
Wilson's can be easily diagnosed by ultrasound whole abdomen, which will show the enlargement of liver ( due to copper deposits ) as well as the AST, ALT will be persistently high.
You can do Ultrasound/ CT Abdomen for the same.