Thread by @drabbyphilips

1/A horrific patient scene today. A #kidney #transplant patient doing well since 2015. Had fall and fracture of foot. Underwent surgery,improving. Asked for physio sessions to continue at home. Asks around,finds #ayurvedic traditional healer. He does external works.

2/ patient feels better. #Ayurveda healer gets his trust. Says post transplant infections and diabetes worsen (patient was already diabetic kidney disease for which transplant was done). Says #natural is safest way. Patient falls for healers confidence. Starts #herbal drugs.

3/ Drugs and potions prepared at home from locally sourced plants. Small fee Healer also advise nutritional changes. More like starvation. No proteins. Remember patient is post kidney transplant. #weightloss in 1 mo. Loss of appetite in 2 months. Then came something unexpected.

4/ Fluid build so bad, in abdomen and legs, he cud barely walk. He was taken to a hospital wer they found his renal functions were over the roof. Started on dialysis. Now came something more sinister. Jaundice. In a matter of days. Liver tests showed evolving severe hepatitis.

5/ all viruses negative, review of prescription drugs non contributory. Jaundice worsened. Patient started having brain failure, or hepatic encephalopathy. Imaging of liver showed areas of patchy vascular loss. Huge liver. Fluid so much, that 8 to 10 L was drained.6

6/ went into a coma, went on ventilator. Went into kidney failure. Started on both liver and kidney dialysis - MARS and CRRT respectively.
Crashed once on ventilator. Revived. Now holding on. But will die.
Why did this happen? What went wrong in a very stable kidney transplant?

7/ Herbal medicines.
The components, included Kurunthotti or Sida Cordifolia which contains pyrrolizidine alkaloids that damage small blood vessels of liver causing the dreaded veno occlusive disease or sinusoidal obstruction syndrome.
en.m.wikipedia.org/wiki/Pyrrolizi…. High death rate.

8/ acute veno occlusive disease of the liver is hardly diagnosed. Once diagnosed,it can be hardly treated. Most require liver transplant sciencedirect.com/topics/pharmac…
Drugs are common causes, but herbs are very dangerous reasons.
ncbi.nlm.nih.gov/books/NBK54803…

9/ A well doing pt will die due to #quackery and blind faith based #pseudoscience such as #ayurveda. Simply criminal. Next time u want to try a Herbal concoction, watch for pyrrolizidine herb components.
#MedTwitter #livertwitter #MedEd #India #AYUSH #hepatitis