1
Saw 64y old #patient with #jaundice and severe #itching all over #body (called #cholestatic #hepatitis) in OPD. Went to 3 other #hospitals prior, always evaluated for #liver and #bileduct #Cancer. Always cancer tests #Negative. Liverbiopsy👇
Biopsy shows severe #bile stagnation (#cholestasis) in liver #cells and bile-ducts with #inflammation and #swelling of livercells (#hepatocyte) - classical picture of cholestatichepatitis. CT of liver normal, #MRCP (to see bile ducts) - normal #livertwitter #pathology
CAUSE👇
Patient has #diabetes. Tired of #insulin #diet control. #Ayurvedic #physician advises - stop insulin, start #natural side effect free #treatment. Gives these #CAPSULE . After 6 months on #tablet - liver injury and symptoms start. #nutrition deprived, sugar controlled. #MedEd
The culprit 👉🔥 Gymnema sylvestre - #ancient #herb with sugar lowering properties. Called as 'Gurmar' (sugar destroyer) in #Ayurvedic #medicine
But can also cause liver injury, itching special. (pubmed.ncbi.nlm.nih.gov/20856101/)
How does it work for #diabetes? #Fascinating! 👇😃
#Gymnema has - Gymnemic acid+gurmarin (#protein) - applied to the tongue, these block sensation of sweetness. Hence patient develops distaste to sugary stuff! bit.ly/3fljU3V
This reduces calorie intake (tooth paste good idea!)
But long intake liver😭 #medicalexperts
I wonder if #specialists have seen such incidents in #practice? #MedTwitter
Always remember to ask #History of herbal #DRUGS use for diabetes control in patients with jaundice +/- itching. This patient is undergoing #plasmatherapy
Diabetes #education is every #clinicians duty