Elevated liver enzymes due to acetaminophen?

Posted by suzfuse46 @suzfuse46, Dec 17, 2022

I will be having surgery in a month and a half for cervical myelopathy and a herniated thoracic disc compressing a nerve root. I am in severe pain but cannot take NSAIDs or opioids with my PCP putting me on acetaminophen at 2250 to 3000 mg per day. I had to have a comprehensive blood test which showed that my ALT (SGOT) was at the upper limit of 39 u/l but the ALT (SGPT) was at 42 u/l when the normal range is 7-25. I can't get an answer from anyone as to whether or not this is a concern and if it shows up in my pre-op exam, it will deter the surgery. I would dearly appreciate any information about the elevated enzymes and the effect on the planned surgery. Thank you.

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@suzfuse46, Here's some information from Mayo Clinic on your question:

"Can acetaminophen cause elevated liver enzymes?
More common causes of elevated liver enzymes include: Over-the-counter pain medications, particularly acetaminophen (Tylenol, others) Certain prescription medications, including statin drugs used to control cholesterol. Drinking alcohol."
— Elevated liver enzymes Causes – Mayo Clinic:
https://www.mayoclinic.org/symptoms/elevated-liver-enzymes/basics/causes/sym-20050830
Have you asked your surgeon?

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Thank you for your reply John. The new PCP took me off Norco and gave me a prescription for Celebrex which chewed up my G.I. tract and flipped me into asthmatic bronchitis. Then she put me on 3,000 mg acetaminophen daily and a blood test I have to get every four months showed the elevated liver enzymes. She has refused to comment on the ALT levels and told me to ask someone else to keep track of it when there isn't another doctor I can ask. I will be having a pre-op clearance appointment on Jan.. 17 and hopefully the levels will go ack to normal by then. I am in so much pain that I don't want anything to interfere with the surgery on Jan. 30, so I don't want to alarm the surgeon at this point. I just wish that I had someone to explain about the meaning of the abnormal level, how much of a concern it is and what I can do to get it back to normal.

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From my experience as a medical professional, I really don’t think that would deter them from surgery. That is just a slight elevation. I’m sure your doctor will relay the same thing to you. Acetaminophen can be taken for short duration’s at 4000 mg per day. If you were taking other medication‘s that are processed through the liver that Hass to be taken into consideration as well. Also, if alcohol is consumed, that is processed through the liver. But overall I would not be that concerned with those numbers at this point. But they do deserve to be watched. I hope that was helpful and relieved some of your stress.

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@dishpain

From my experience as a medical professional, I really don’t think that would deter them from surgery. That is just a slight elevation. I’m sure your doctor will relay the same thing to you. Acetaminophen can be taken for short duration’s at 4000 mg per day. If you were taking other medication‘s that are processed through the liver that Hass to be taken into consideration as well. Also, if alcohol is consumed, that is processed through the liver. But overall I would not be that concerned with those numbers at this point. But they do deserve to be watched. I hope that was helpful and relieved some of your stress.

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Thank you for your reply Dishpain. I will find out hopefully on the 17th if the SGOT has normalized. I don't drink or have any other meds that may have raised the enzyme level. It's good to know that you thought that it was just a slight elevation. That was information that no one would comment on. I will mention in my pre-op appointment that acetaminophen and NSAIDs are something that possibly should not be given to me after the surgery in view of the bad experience with them recently.

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@suzfuse46

Thank you for your reply Dishpain. I will find out hopefully on the 17th if the SGOT has normalized. I don't drink or have any other meds that may have raised the enzyme level. It's good to know that you thought that it was just a slight elevation. That was information that no one would comment on. I will mention in my pre-op appointment that acetaminophen and NSAIDs are something that possibly should not be given to me after the surgery in view of the bad experience with them recently.

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Yes. I hope that anything that I comment on would be helpful. I think that’s what we’re all here for is to support and give our experiences. I hope everything goes well!

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I have taken Tylenol for over 20 years. I take two 500 mg twice a day. For Scoliosis! I do not drink or smoke. So far no problems.

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@suzfuse46

Thank you for your reply Dishpain. I will find out hopefully on the 17th if the SGOT has normalized. I don't drink or have any other meds that may have raised the enzyme level. It's good to know that you thought that it was just a slight elevation. That was information that no one would comment on. I will mention in my pre-op appointment that acetaminophen and NSAIDs are something that possibly should not be given to me after the surgery in view of the bad experience with them recently.

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NSAIDs can also have a negative effect on some anti hypertension meds too. I had to stop all NSAID meds due to this and only take Turmeric 2400mg 3x day.

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@jenatsky

NSAIDs can also have a negative effect on some anti hypertension meds too. I had to stop all NSAID meds due to this and only take Turmeric 2400mg 3x day.

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Hello Jules,
We have messaged before. Today I just passed my pre-op exam for surgery on my cervical spine replacing hardware from C3 -6, with laminectomy and fusion down toT1, continuing down to and correcting the herniation at T10-11. I refused to go back on opioids, specifically the Buprenorphine. PCP prescribed Celebrex which chewed up my GI tract from Nov. 1 and is still going strong. Then she prescribed acetaminophen which elevated my liver enzymes so I stopped taking it fearing that it might prevent my being able to have the surgery. I have been in severe pain since Oct. 16 when I weaned myself off the Norco. The only thing that has helped me get through the pain is putting one foot in front of the other moving forward with plans to have the surgery on Jan.30. I changed my PCP to one in the health system that the neurosurgeon belongs to so I no longer have to deal with the patient rights violations of the former PCP. I just hope that nothing else can interfere with the surgery since 3 1/2 years of P.T., epidurals and RFAs failed to relieve anything. Thank heaven's high blood pressure is one thing I don't have to deal with since most of the time I'm on the hypotensive side. You have had a lot to figure out with your health and fortunately are good at it.

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Well being a radiology tech prior to getting my nursing degree, then I became a medical coder and worked for hospitals collecting under paid contracted services. I can easily see how someone can become confused by all the techie stuff and medical lingo and drug interaction. You’ve been through a great deal and I’m curious about one thing. What has been your typical daily fluid intake on a regular basis?

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I had to have bariatric surgery prior to my L-4 – L5 surgery. Could NOT exercise due to movement forward 54%. Had to have bariatric surgery to get to the requested doctor wait requirement one year of only 5 PROTEIN SHAKES A DAY. Can't look at ANY type of shake in the face EVER again, lol… Anyway.. they said NSAIDs would cause ulcers, and zero fried foods… greens, veggies a problem… OH, I could go on!!! Vegetarian here.
You SHOULD be able to get a prescription for "less than Opioids" (though frankly it angers me we aren't afforded those either.)

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