Hello, I read your message carefully and I understood your problem. I see your resident has developed high liver enzymes and rash quite sudden. She has been on ranitidine treatment for GERD. Ranitidine rarely gives hepatic troubles. Hepatic damage happens in the case of the drug hypersensitivity. It may cause an increase of serum concentrations of hepatic enzymes called transaminases. Also, skin rash and eosinophilia are present. These are symptoms that usually appear in the first hours/days of using the drug. I think your resident should stop taking ranitidine. Further consultation with her doctor is advised in order to measure the liver enzymes (liver function test). Gallbladder should be also evaluated by abdominal ultrasound in order to exclude related damages. If liver damages from ranitidine use will be confirmed, the doctor will prescribe another drug to dominate her GERD. Advise her not to drink alcohol and follow a healthy diet. Hope this was helpful. Dr.Albana