October - LRS Institute of Tuberculosis & Respiratory Diseases
October - LRS Institute of Tuberculosis & Respiratory Diseases
October - LRS Institute of Tuberculosis & Respiratory Diseases
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LIVER ENZYMES DURING TREATMENT WITH RESERVE REGIMEN<br />
229<br />
TABLE 8<br />
Details <strong>of</strong> cases <strong>of</strong> Clinical Jaundice<br />
Sl. Age & Hb. Weight Pre-treatment level Duration Level <strong>of</strong> Inter- Regimn resumed or<br />
No. Sex (gm%) in kg <strong>of</strong> present serum repution not<br />
LDH SGPT Serum treatment bilirubin <strong>of</strong> treat-<br />
(I.U/ (I.U/ Alk. ment<br />
litre) litre) Phos.<br />
(K.A.<br />
Unit)<br />
1. 25 F 8.5 25 200.4 8.0 7.08 9 days 12 mg% 12 days Pyrazinamide omitted,<br />
Rifampicin & Ethambutol<br />
restarted. Patient<br />
tolerated well.<br />
2. 25 F 6.8 27 300.6 20.0 16.70 10 days 12.4 mg% 16 days Pyrazinamide omitted.<br />
Rifampicin and<br />
Ethambutol restarted.<br />
Tolerated well.<br />
3. 60 F 7.5 30 300.6 8.0 3.20 12 days 10.4mg% 18 days Rifampicin +<br />
Pyrazinamide +<br />
Ethambutol resumed<br />
but patient had raised<br />
LDH, SGPT and<br />
serum bilirubin at 60<br />
days <strong>of</strong> treatment and<br />
followed subsequently<br />
without any ill effect.<br />
alkaline phosphatase at 15 and 30 days <strong>of</strong><br />
treatment whereas fall in the levels by 60th day<br />
is significant.<br />
3 (12 %) cases developed clinical jaundice during<br />
this study. Pre-treatment levels <strong>of</strong> liver<br />
enzymes, under study, are as shown in Table<br />
8. All were females and their duration <strong>of</strong> treatment<br />
was from 9 to 12 days (mean 10 days)<br />
indicating the average time for clinical jaundice.<br />
Interruption <strong>of</strong> treatment was from 12 to 18<br />
days (mean 15 days). All were severely malnourished,<br />
almost half <strong>of</strong> the average weight. One<br />
<strong>of</strong> them was severely anaemic (6.8 gm% haemoglobin)<br />
and the two others had moderate<br />
anaemia with 7.5 gm% and 8,5 gm % haemoglobin.<br />
One (4%) continued with the regimen and<br />
had raised values <strong>of</strong> LDH and SGPT and serum<br />
bilirubin at the end <strong>of</strong> 60 days <strong>of</strong> treatment and<br />
followed up subsequently without any ill effect.<br />
2(8%) had pyrazinamide omitted thinking that<br />
this drug might be responsible for damage to<br />
the liver and rifampicin and ethambutol were restarted<br />
without any ill effect. It can be concluded<br />
that this regimen should be used with<br />
great caution in those who have demonstrable<br />
hepatic dysfunction.<br />
Discussion<br />
Serum lactate dehydrogenase and serum<br />
glutamic pyruvic transaminase were used as<br />
an index <strong>of</strong> hepatocellular damage and serum<br />
alkaline phosphatase was used as an index<br />
for cholestasis. Litchman (1953) pointed out<br />
that in pulmonary tuberculosis clinical observations<br />
demonstrate a lack <strong>of</strong> parenchyma] hepatic<br />
damage contrary to the presence <strong>of</strong> such hepatic<br />
damage as revealed by sensitive hepatic tests,<br />
In our study also, none <strong>of</strong> the patients had any<br />
clinical signs <strong>of</strong> involvement <strong>of</strong> the liver or<br />
jaundice before the start <strong>of</strong> treatment though<br />
subclinical involvement <strong>of</strong> the liver was there<br />
as is revealed by the pre-treatment liver<br />
enzyme levels in the abnormal group.<br />
It can be concluded from the given data<br />
that mean enzyme activity in abnormal group<br />
start falling after treatment by 30th day onwards<br />
whereas in normal group, mean enzyme activity<br />
Ind. J. Tub., Vol. XXIX, No. 4
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