Was It a Mistake for the PA to Send Me Home from the ER?
At 21 years old, I found myself in the ER due to a series of concerning symptoms: extreme fatigue, aches throughout my body, pain in my upper abdomen (on both the left and the right sides), back pain, nausea, swollen tonsils, a sore throat, headaches, and abnormal dark brown urine. My blood tests revealed notably elevated liver enzymes: AST at 514, ALT at 734, alkaline phosphatase at 297, and bilirubin at 2.3. Additionally, the monospot test confirmed my suspicion of mononucleosis. I do not have any significant health issues, apart from mild asthma, and was not on any medication at that time. I had previously experienced mono at age 16, which was only mild in comparison to this episode. During my visit, the PA seemed to dismiss my condition after the monospot test results arrived, attributing the abnormal liver enzyme levels to the mono diagnosis. Despite feeling utterly miserable, suffering from considerable abdominal and back pain, and having liver enzymes that were alarmingly high for someone my age and general health, I was sent home without further treatment. Surely, they could have at least provided some IV fluids? It is well-known that mono has no specific treatment, but the elevated liver enzymes seemed serious. Just a few days later, I noticed yellowing of my skin and eyes, prompting my primary care physician to insist I return to the ER, expressing disbelief over my initial discharge given the concerning lab results. What’s your perspective on this situation?
Answers (1)
6/23/2025, 6:30:47 PM
OpenHealth AI
It's understandable to feel frustrated and concerned about your experience in the ER, especially given the combination of severe symptoms and elevated liver enzymes you presented. Let's break this down.
Main Points
Your symptoms and lab results indicated a serious condition, particularly with the significantly elevated liver enzymes and subsequent jaundice (yellowing of skin and eyes). The mononucleosis diagnosis can lead to complications, and elevated liver enzymes can signify issues that require ongoing monitoring.
Explanation
Mononucleosis, caused by the Epstein-Barr virus, typically resolves on its own, but it can lead to liver inflammation, particularly in severe cases. The elevated liver enzymes (AST, ALT, alkaline phosphatase) you reported are concerning and shouldn't be overlooked. Your symptoms, including abdominal pain, back pain, and jaundice, suggest that your liver may have been under significant stress, and this warrants careful attention.
The decision to send you home after the initial assessment may have been based on several factors, including the PA's clinical judgment at the time. However, that decision appears to have not fully accounted for the seriousness indicated by your lab results and overall clinical picture.
Next Steps
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Follow-Up with Your Primary Care Physician: Since you’ve already been advised to return to the ER by your primary care doctor, it’s important to follow through with that visit. Ensure that your concerns regarding your liver health and symptoms are clearly communicated.
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Monitor Symptoms Closely: Keep a detailed log of your symptoms, including any new developments or changes, especially regarding your fatigue, abdominal pain, jaundice, or any other significant symptoms. This documentation can be helpful for your healthcare team.
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Hydration and Rest: Continue to prioritize rest and hydration. Adequate fluid intake can help support your liver function and overall recovery, especially when dealing with viral infections.
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Avoid Alcohol and Liver Stressors: It’s crucial to avoid alcohol and any substances that could further strain your liver while you recover. This includes over-the-counter medications like acetaminophen unless approved by your healthcare provider.
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Consider Future Monitoring: Depending on your follow-up results, it might be advisable to discuss maintaining a watchful eye on your liver function with your healthcare provider. Regular blood tests may be necessary to monitor liver enzyme levels.
It's important to feel heard and validated in your health concerns, and your experience reflects the complexity of diagnosing and managing such conditions. Stay proactive in your care, and don’t hesitate to seek further evaluation if things don’t improve.
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