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Medical Forum / General / General / March 2007Pancreatitis from meds
Good day, my granny (98 yo) suffers from pancreatitis episodes, she already went to hospital 3 times and she always risked to die. The pancreatitises are supposed to be from gallstones origin, however these are inoperable because of her age etc. But she always had them, while the pancreatitis episodes are relatively recent. I noticed that two meds she has taken recently (and continues to take) can cause sporadic pancreatitis episodes under cronic assumption: enalapril maleate and furosemide. There is quite a lot of literature on Pubmed on this, and for both meds. I understand that the gallstones probably do a good part of the job, but inflamations IMHO are additive. I noticed that among ace-inhibitors almost all are reported to have caused some episodes of pancreatitis in literature except Fosinopril (and Imidapril but that is not sold in my country). What do you think about an enalapril to fosinopril replacement? I am not a doctor. If you think it's reasonable I would like to try to convince our doctor to prescribe fosinopril (that won't be easy knowing our doctor so at least I would like to know your opinion before). The other one is furosemide. This I believe is even more difficult to replace: almost all the other diuretics are reported to cause sporadic pancreatitis episodes. The only class which does not have this problem I think is anti-aldosterone. I know nothing of anti-aldosterones... can they replace furosemide in an old woman with some hearth problems (chronic atrial fibrillation, some degree of cardiac insufficiency). Thanks in advance > Good day, > my granny (98 yo) suffers from pancreatitis episodes, she already went to [quoted text clipped - 27 lines] > replace furosemide in an old woman with some hearth problems (chronic > atrial fibrillation, some degree of cardiac insufficiency). Gallstone pancreatitis and chemical pancreatitis from those meds are two completely different mechanisms and her doctor should have no difficulty in determining which of the two mechanisms is the cause of her recurrent pancreatitis. I think one can be fairly certain that the basis is gallstones and that her meds are not contributing in any way. Obviously, she needs to have her gallbladder removed. The risk of her dying from that operation may very well be less than the risk of three or more episodes of pancreatitis. Her doctors have likely put her at far greater risk by NOT taking her gallbladder out. HMc > "plutu" <plutu@walt-disneu.com> wrote in message > > Gallstone pancreatitis and chemical pancreatitis from those meds are two > completely different mechanisms and her doctor should have no difficulty in > determining which of the two mechanisms is the cause of her recurrent > pancreatitis. This is interesting but contrary to what I knew... I think I read in a paper something like "the pancreatitis from meds has no distinguishable features..." Anyway: can you provide more detailed info about how to discriminate between the two? At the hospital they just said that "when they find gallstones they assume that the reason for the pancreatitis is gallstones and not a rare side effect from a widely used medication" This leads me to believe that they didn't do a real estimation of what you say. If you can tell me more about the differences... > I think one can be fairly certain that the basis is gallstones > and that her meds are not contributing in any way. > Obviously, she needs to have her gallbladder removed. The risk of her dying > from that operation may very well be less than the risk of three or more > episodes of pancreatitis. This was my opinion also but they didn't want to operate her. The anesthesist said she probably would not have passed the anesthesia. They didn't speak about precise likelihoods. Probably they thought that a death during an operation was not good for their career, while the patient was alive and could be dismissed... :-( It is sad but I kinda understand this. Thanks for your help >> "plutu" <plutu@walt-disneu.com> wrote in message >> [quoted text clipped - 35 lines] > > Thanks for your help "When you hear hoofbeats, think of horses, not zebras". Common things present commonly...pancreatitis in the presence of stones in the gallbladder is presumed to be gallstone pancreatitis. That it might be due to medication is pretty much just wishful thinking. In an episode of gallstone pancreatitis, one might expect to see elevated direct bilirubin and alkaline phosphatase as well as radiographic evidence of an enlarged common bile duct. HMc > "When you hear hoofbeats, think of horses, not zebras". > [quoted text clipped - 5 lines] > direct bilirubin and alkaline phosphatase as well as radiographic evidence > of an enlarged common bile duct. Thanks Direct bilirubin normal at 0.18 mg/dl Alkaline phosphatase elevated at 687 MU/ml however captopril is reported to elevate alkaline phospatase sometimes http://www.rxlist.com/cgi/generic/captop_ad.htm so it might be the same for enalapril ecography results: (translating to english at my best...) "Choledochus at ilum measures 5mm and does not contain stones." I think 5mm is normal, right? "Cholecistis is 'hydropic' (? maybe) and contains numerous stones of 14-22 mm of size and biliary sludge." 14mm are not likely to pass IMO. The other reason that leads me to think "meds" is that at the previous hospitalization they said that the gallbladder (or duct?) was so much blocked with stones that stones would probably not pass anymore, hence they said this was probably the last pancreatitis she would have had. Which turned out to be not true... TIA >> "When you hear hoofbeats, think of horses, not zebras". >> [quoted text clipped - 28 lines] > they said this was probably the last pancreatitis she would have had. > Which turned out to be not true... Perhaps their whole proposed scenario makes more sense to someone who's actually on-scene, and can review all the lab work/xrays, get a history, and examine the patient. From here, it sounds like she's being mismanaged. HMc |
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