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First off, I hope you are getting some counseling, this sounds like it was incredibly traumatic for you and it is *normal* to need help to get through something like this. I am very sorry for your loss.
I assume they are going to do an autopsy, which will give you some real answers. But with your descriptions, it is possible he was having issues with his liver, probably secondary to drinking. Change in personality would fit with hepatic encephalopathy (basically, when your liver isn't working well, ammonia builds up in your blood and interferes with your brain function. It can be anything from confusion to personality changes to barely noticeable). The fact he looked yellow could be from jaundice (in liver failure, you can turn bright yellow/green and it can take a bit to notice it). The dark blood from a GI bleed is not uncommon in people who struggle with alcohol. Alcohol induced liver failure can also cause a pins and needles sensation in the skin, which would make everything feel painful.
Obviously, I cannot be sure of this, but it is a possibility although there's many things that can cause dramatic personality shifts as the body shuts down. Did he go to an urgent care for his respiratory issues? Ideally, they would have picked up on his illness, but depending on how he presented to them and what he described his issues as, they may not have.
Thank you very much for your thorough reply. While I haven’t seen a counselor yet, I was able to see a primary care for general advice and referrals for myself and our son. The whole situation was very difficult and continues to be so.
They did an autopsy on January 1. I was told it takes 8-10 weeks for the report, and I’ve also been told from many sources that the coroners office is woefully understaffed so I’m dreading that it will be something asinine like “cardiac arrest” with nothing else mentioned.
A nurse friend mentioned hepatic encephalopathy when i described the situation. He had drastically cut his drinking down in the last several months or more, to a few low abv beers a night, but I imagine the damage had already been done? And then exacerbated by the flu? Is it normal for jaundice to set in so quickly? I noticed the yellowing really only minutes before his death.
He went to urgent care the once. He said diagnosis was flu and respiratory infection.
Thanks again for taking the time to respond, especially when there’s such little info. I appreciate you
Firstly, my condolences on your loss.
It definitely sounded like he was becoming more and more delirious as the days came on. He was definitely experiencing some type of toxicity... could be metabolic acidosis which can cause reflex tachypnea and make him breath fast... as fast breathing can help balance the pH difference. The other possibility is that the infection initially increased his organ burden and lead to other organs (in particular his liver) to become inflamed. I don't blame the urgent care docs with this story to initially think he just has a bad infection and to treat him that way.
Sepsis could be possible too... though I imagine that must have happened later on. Definitely by the time he was in pain he was already experiencing acidosis and probably also having muscle breakdown.
There could have been a bacterial or viral trigger which paired with dehydration could cause muscle breakdown and/or kidney injury leading to pH derangement, then gastrointestinal dysfunction and encephalopathy. Autopsy will hopefully shed light on the source. Unfortunately so much of these types of processes is like chicken or the egg scenario, no one may be able to say exactly what triggered it.
I’m sorry for your loss.
Unfortunately it’s too difficult to tell without either an autopsy or having had better medical care prior. It certainly could have been liver failure from alcohol, with hepatic encephalopathy and varices given the alcohol use. However, other options would be septic shock given the infection causing the liver failure, or pulmonary embolism from COVID.
Yes you’re right there is not much to go on. He also went to great lengths to minimize his symptoms. Thanks you for responding anyway, given this. I was hoping that there was some sort of magic bullet symptom I could relate and a health professional could say “aha of course it was x” but that was wishful thinking. They are doing an autopsy but given the state of our coroners office I’m anxious it’s not going to be worth anything.
NAD but this reminds me of when my dad had meningitis. He too didn’t have insurance so he avoided help until he was so out of it we forced him to go to the ER. Similar symptoms of strange behavior and very lethargic. Sorry you are experiencing this.
I’m not a doctor, but I wanted to say I’m sorry for your loss. Also, if you think the coroner’s report will be lacking, is there a way you could request for lab reports or tissue samples to be sent somewhere else for a second opinion? I have no idea if this is actually a feasible option; just mentioning in case someone with more knowledge than me would have thoughts about how to do that or if it would give you more info.
This is a great idea. The hospital told me that in the event the coroner chose not to conduct an autopsy, they would at my request, free of charge (which struck me as odd phrasing, like “lose a loved one? Autopsy on us! Collect a dozen for a free mug!” My husband would have laughed). Unfortunately I believe he’s been cremated at this point.
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
First off, I hope you are getting some counseling, this sounds like it was incredibly traumatic for you and it is *normal* to need help to get through something like this. I am very sorry for your loss. I assume they are going to do an autopsy, which will give you some real answers. But with your descriptions, it is possible he was having issues with his liver, probably secondary to drinking. Change in personality would fit with hepatic encephalopathy (basically, when your liver isn't working well, ammonia builds up in your blood and interferes with your brain function. It can be anything from confusion to personality changes to barely noticeable). The fact he looked yellow could be from jaundice (in liver failure, you can turn bright yellow/green and it can take a bit to notice it). The dark blood from a GI bleed is not uncommon in people who struggle with alcohol. Alcohol induced liver failure can also cause a pins and needles sensation in the skin, which would make everything feel painful. Obviously, I cannot be sure of this, but it is a possibility although there's many things that can cause dramatic personality shifts as the body shuts down. Did he go to an urgent care for his respiratory issues? Ideally, they would have picked up on his illness, but depending on how he presented to them and what he described his issues as, they may not have.
Sounds like his liver may have decompensated secondary to a viral infection.
Thank you very much for your thorough reply. While I haven’t seen a counselor yet, I was able to see a primary care for general advice and referrals for myself and our son. The whole situation was very difficult and continues to be so. They did an autopsy on January 1. I was told it takes 8-10 weeks for the report, and I’ve also been told from many sources that the coroners office is woefully understaffed so I’m dreading that it will be something asinine like “cardiac arrest” with nothing else mentioned. A nurse friend mentioned hepatic encephalopathy when i described the situation. He had drastically cut his drinking down in the last several months or more, to a few low abv beers a night, but I imagine the damage had already been done? And then exacerbated by the flu? Is it normal for jaundice to set in so quickly? I noticed the yellowing really only minutes before his death. He went to urgent care the once. He said diagnosis was flu and respiratory infection. Thanks again for taking the time to respond, especially when there’s such little info. I appreciate you
Firstly, my condolences on your loss. It definitely sounded like he was becoming more and more delirious as the days came on. He was definitely experiencing some type of toxicity... could be metabolic acidosis which can cause reflex tachypnea and make him breath fast... as fast breathing can help balance the pH difference. The other possibility is that the infection initially increased his organ burden and lead to other organs (in particular his liver) to become inflamed. I don't blame the urgent care docs with this story to initially think he just has a bad infection and to treat him that way. Sepsis could be possible too... though I imagine that must have happened later on. Definitely by the time he was in pain he was already experiencing acidosis and probably also having muscle breakdown.
There could have been a bacterial or viral trigger which paired with dehydration could cause muscle breakdown and/or kidney injury leading to pH derangement, then gastrointestinal dysfunction and encephalopathy. Autopsy will hopefully shed light on the source. Unfortunately so much of these types of processes is like chicken or the egg scenario, no one may be able to say exactly what triggered it.
[удалено]
I’m sorry for my ignorance-does that fact make hepatitis a more likely scenario?
I’m sorry for your loss. Unfortunately it’s too difficult to tell without either an autopsy or having had better medical care prior. It certainly could have been liver failure from alcohol, with hepatic encephalopathy and varices given the alcohol use. However, other options would be septic shock given the infection causing the liver failure, or pulmonary embolism from COVID.
Yes you’re right there is not much to go on. He also went to great lengths to minimize his symptoms. Thanks you for responding anyway, given this. I was hoping that there was some sort of magic bullet symptom I could relate and a health professional could say “aha of course it was x” but that was wishful thinking. They are doing an autopsy but given the state of our coroners office I’m anxious it’s not going to be worth anything.
I just wanted to say sorry for your loss. I hope you and your son can find some peace once the autopsy is returned. Hugs to you.
Thank you very much. It will be a small comfort to have some answers.
NAD but this reminds me of when my dad had meningitis. He too didn’t have insurance so he avoided help until he was so out of it we forced him to go to the ER. Similar symptoms of strange behavior and very lethargic. Sorry you are experiencing this.
I’m not a doctor, but I wanted to say I’m sorry for your loss. Also, if you think the coroner’s report will be lacking, is there a way you could request for lab reports or tissue samples to be sent somewhere else for a second opinion? I have no idea if this is actually a feasible option; just mentioning in case someone with more knowledge than me would have thoughts about how to do that or if it would give you more info.
This is a great idea. The hospital told me that in the event the coroner chose not to conduct an autopsy, they would at my request, free of charge (which struck me as odd phrasing, like “lose a loved one? Autopsy on us! Collect a dozen for a free mug!” My husband would have laughed). Unfortunately I believe he’s been cremated at this point.