ALF - losing consciousness

[chiefs2012]

My dad has been diagnosed with Advanced Liver Failure while in the hospital a few weeks ago. His blood oxygen level was in the 40's and he received a blood transfusion. Since he has been home he has had several episodes of comatose states, he'll be laying down talking one minute then a few minutes later his eyes will be open but nobody's home. When this happened he had shallow breathing and a very rapid heartbeat, 120b/min. and his blood oxygen level was 46. It took a long time to get him aroused and awake. He has been sleeping for 2 days with little awakenings here and there. This morning was another episide of his eyes being open but he wasn't there and he had also wet the bed. His blood oxygen this time was 92 and his temp normal. We let him sleep for awhile then woke him up but had a very hard time getting him out of this state. Since then he has pretty much slept all day. He is/was a heavy drinker, on oxycontin (40mg), COPD as well as CHF. I am just worried or wondering what the loss of consciousness recently means. I have tried researching possible seizures? Or is it possibly to the point the toxins are affecting his brain? Just wondering if these spells of unconsciousness with eyes open has happened to anyone else. Just looking for some answers or input.

[chiefs2012]

Thanks for the feedback, have you seen this type of thing before? Just wondering as you seem to think his days are numbered with these current symptoms? Also you seem to be a fan of KU Med are you affiliated with them? I have heard great things about the hospital and their research. Basically the local hospital he was in did an evaluation and after 2 days of being admitted they gave him a blood transfusion then did a scope of his stomach. His hemoglobin was around 7. He has a few ulcers and the lining of his stomach is very inflammed, also has/had some internal bleeding. They think because of the ulcers. He has been extremely constipated so they were unable to do a colonoscopy and has yet to do one, been 3 weeks since his release. All they were told is they think he's in Advanced Liver Failure and to quit drinking. As far as I know they didn't do much else. Just to schedule a follow up within a month. Upon returning home from the hospital he has gotten a little worse since before he was admitted. Hence the comatose spells and all the sleeping. My mom thinks it was just from all the activity of getting him up and out of the house - he isn't walking and in a wheelchair. Lots of fluid retention, nose bleeds and even bleeding on the skin when she scratches his back. He has the shakes or asterixis as you called it? And we haven't seen this for that long, been fairly recent. He is not jaundiced at all though.  I would love for him to be evaluated from a more elite team of doctors as it's another story to talk him into it. I don't think he thinks he's at that "stage" yet of urgency. His health has slowly declined over the past few years and we've watched him live in misery for quite awhile now, so not sure how long we want to continue this way, though he does say he wants to live. I think he's closer to death than my mom does, so that's why I came looking for similar stories to see if his current episodes are a telltale sign.  I do appreciate all your help and feedback! All the best!

[HectorSF]

I am very sorry to hear about your father's very advanced liver disease.

It appears that he is experiencing episodes of hepatic encephalopathy (HE). HE is one complication of advanced liver disease. End-Stage Liver Disease. This is caused by toxins from food traveling through his blood to his brain. There are treatments for HE and he should be receiving them from a hepatologist or a gastroenterologist at a large hospital that has  department that specializes in liver disease and its complications. He has very advanced HE, which is very dangerous and can lead to death. He could go into a coma and never come out of it. Your father needs medical help ASAP!!! You should get him to a liver transplant center or liver disease clinic near by ASAP. He should be under the care of a liver specialist and his disease should be monitored closely. The local hospital does not has the knowledge or expertise to help him. What did they tell you when he was released from the hospital? Did they say anything about getting hospice care?

Call The University of Kansas Hospital and tell them your situation and request an appointment ASAP. If your father continues to sleep and be blank take him to the ER at the University hospital. They can help him.

The University of Kansas Hospital -
You or your doctor can request a liver transplant evaluation. One of our nurse coordinators will contact you to schedule your initial visit. You'll meet with a multidisciplinary liver transplant team that will thoroughly assess your overall physical and psychological condition to determine your best treatment option.

If a liver transplant is the right course of treatment for you, our liver specialists will provide comprehensive care and education, from your first evaluation through your liver transplant and for the rest of your life.

Request an evaluation
913.588.1227
Toll free 800.332.6048

Here is a link to their website...
http://www.kumed.com/medical-services/transplant-services/liver-transplant

" He is/was a heavy drinker, on oxycontin (40mg), COPD as well as CHF."
Unfortunately if your father is still using alcohol and drugs he will not be able to get a liver transplant to save his life. He will need to be sober for at least 6 months and he will have to convince the transplant team that he will not drink or take drugs again for the rest of his life or he would be able to get a life-saving transplant. Having COPD as well as CHF may make it impossible for him to get a transplant anyway. But they can perhaps stabilize him and allow him more time to live.

It sound like your father is close to the end. You need to get him medical help ASAP. If I were you I would take him to The University of Kansas Hospital today. He could go to sleep and never wake up.

Symptoms of Hepatic Encephalopathy:
lethargy, somnolence (sleeping), loss of mental function, profound confusion, amnesia, aggression, asterixis (hand flapping), and hyperactive reflexes. Coma. In the coma stage, respiratory or cardiovascular failure may occur.

I wish you the best. You are in a very difficult and sad situation.
If I can help in any other way let me know.
Hector