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Ask Dr.Saleem Your Own Question
Dr.Saleem, Doctor
Category: Medical
Satisfied Customers: 5059
Experience:  MBBS
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My son was diagnosed with ulcerative colitis last summer and

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Hi my son was diagnosed with ulcerative colitis last summer and takes mesalazine daily and is currently on a course of prednisolone (40mg daily, reducing by 5mg a week - currently at 30mg a day) and has just started azathioprine treatment (100mg a day at present), due to constant flaring. On top of this he recently was diagnosed with pericarditis ( 3 weeks ago) although symptoms have now cleared and a suspected infection in his colon, for which he was given a weeks course of metronidazole ( which he finished 2 days ago). My question is, for the last week he has been on the metronidazole he has been experiencing a nasty taste in his mouth and nausea feeling, but he has just told me that his saliva also changed colour. I have just asked him to spit in the sink and it is a very pale pink colour. What I wanted to know is, could this discolouration ( I'm assuming the pale pink colour is due to blood?) of his spit/saliva be due to all the medication he is taking (steroids, immuno suppresants etc) or the antibiotics he has just finished, or should I be contacting his gastroenterologist with concerns that is something more serious?

Hello and welcome to JA. Dr Saleem here. Will be answering you shortly

Well the metallic taste is definitely due to metronidazole. Azathiopurine can cause bone marrow suppression and so low cell counts and thus easy bleed. Similarly steroids are irritant to stomach lining and can cause ulceration there. The commonest and most likely cause here would be gum bleed thats too small and only noticed when mixed with saliva in his case. As he has just started azathiopurine so gross decline in cell counts is also less likely this early. Nothing much of concern ,just keep an eye on saliva color and observe for any rash, bleed from nose, gums , in stool etc.

Monitor azathiopurine with periodic complete blood counts initially atleast fortnightly.

Take omeprazole or any other antacid to protect the stomach lining too.

Hope it answers your query.

Let me know if you have any more queries.

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Stay blessed.


Customer: replied 1 year ago.
Many thanks for your reply, that has certainly put my mind at rest. Can I just check, my son's GP has just prescribed him Ranitidine as he is on steroids, to protect his stomach, but would this affect the blood tests for the azathioprine, as I read the Ranitidine can also affect liver function?

No not really its generally safe to take Ranitidine. Used with caution only when there is liver damage already due to some other cause.

Customer: replied 1 year ago.
That's great. Thank you so much. I'll start my son on the Ranitidine straight away and hopefully this may help the problem if the steroids were the cause of the bleeding on his stomach lining. I will also check with him to see if the pink spit is only there after teeth brushing, or if it is there all day. Just before I finish, could I just check, in your opinion that this isn't related to his recent episode of pericarditis? Many thanks

Well its unlikely to be a result of that. Only if he gets breathless with coughing up of pinkish sputum is when you should seek professional help immediately .

Dr.Saleem and 3 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
That's great, I just wanted to make sure. He is not breathless at all. Thank you so much for your help, it is much appreciated.

You are most welcome.

Best regards.

Dr Saleem.