Acute hepatic failure

Nausea Vomiting Insomnia Headache Acute hepatic failure ... 

Valproic add Cl upset Acute hepatic failure Polycystic ovary-like syndrome... 

Gastric distress (nausea and vomiting) is one of the most frequently reported adverse reactions. Bladder irritation (e.g., dysuria, polyuria, hematuria, and urgency) may occur. The mandelic salt can crystallize in urine if there is inadequate urine flow and should not be given to patients with renal failure. Patients with preexisting hepatic insufficiency may develop acute hepatic failure due to the small quantities of ammonia formed during methenamine hydrolysis. 

Rare but serious adverse effects of all anti-TNF agents also include severe hepatic reactions leading to acute hepatic failure, demyelinating disorders, hematologic reactions, and new or worsened congestive heart failure in patients with underlying heart disease. 

Harrison, R.J., Pasternak, G, Blanc, P, Basuk, P. Letz, G. (1985) Acute hepatic failure after occupational exposure to 2-nitropropane. Morbid. Mortal. WklyRep.. 34, 659-665... 

A patient developed atorvastatin-induced severe autoimmune hepatitis and a lupus-like syndrome. Although the drug was immediately withdrawn, the disease persisted and deteriorated to a fulminant form with acute hepatic failure. There was no response to conventional immunosuppression with glucocorticoids and azathioprine. Only the introduction of intense immunosuppressive therapy, as used in solid organ transplantation, led to a complete and sustained recovery. The patient had the HLA haplotypcs DR3 and DR4, which are well-known genetic factors associated with autoimmune diseases. 

Adverse effects of the COMT inhibitors relate in part to increased levodopa exposure and include dyskinesias, nausea, and confusion. It is often necessary to lower the daily dose of levodopa by about 30% in the first 48 hours to avoid or reverse such complications. Other side effects include diarrhea, abdominal pain, orthostatic hypotension, sleep disturbances, and an orange discoloration of the urine. Tolcapone may cause an increase in liver enzyme levels and has been rarely associated with death from acute hepatic failure accordingly, its use in the USA requires signed patient consent (as provided in the product labeling) plus monitoring of liver function tests every 2 weeks during the first year and less frequently thereafter. No such toxicity has been reported with entacapone. 

Hepatic 7 (acute hepatic failure with jaundice, enlarged liver, and greatly increased serum bilirubin) ... 

Acute hepatitis Acute hepatic failure Chronic hepatitis, Cirrhosis Obstructive jaundice. Cholestasis, Primary biliary eirrhosis... 

Nakadate, I., Nakamura, A., Endo, R., Iwai, M., Kaneta, H., Shimo-tono, H., Sasaki, S., Takikawa, Y., Yamazakl, K., Madarame, T., Kashi-wabara, T., Suzuki, K., Sato, S. Autoimmune hepatitis presenting with acute hepatic failure. Acta Hepatol. Xapon. 1993 34 665-671... 

Schneeweiss, B., Pammer, X, Ratheiser, K., Schneider, B., Madl, C., Kramer, L., Kranz, A., Ferenci, R, Druml, W., Grimm, G., Lenz, K., Gangl, A. Energy metabolism in acute hepatic failure. Gastroenterology 1993 105 1515-1521... 

Ash, S.R., Blake, D.E., Carr, D.J., Harker, K.D. Push-pull sorbent based pheresis for treatment of acute hepatic failure the Biologic-detoxifier/plasma filter system. ASAIO X 1998 44 129-139... 

Rahman, T.M., Hodgson, H.J.F. Review article liver support systems in acute hepatic failure. Aliment. Pharm. Then 1999 13 1255-1272... 

Joshl, Y.K., Tandon, S.K., Acharya, S.K., Babu, S., Tandon, M. Acute hepatic failure due to Plasmodium falciparum liver injury. Liver 1986 6 357-360... 

Triger, D.R., Goepel, J.R., Slater, D.N. Systemic candidiasis comphcat-ing acute hepatic failure in patients treated with cimetidine. Lancet 1981/11 837-838... 

Coinfections HGV-C has no deleterious effect on the course or treatment of chronic hepatitis C (115) despite conflicting observations. The simultaneous detection of TT viruses in the serum or hepatocytes, particularly with type lb and at an advanced stage of the disease, does not have an unfavourable effect (146). Coinfection with HBV leads to aggravation of the condition. Acute hepatic failure must also be anticipated, as is the case in HAV and HBV concomitance. (I4l) Active inoculation is therefore recommended for lack of immunity against HAV and HBV. 

The hepatopulmonary syndrome (HPS) may occur in patients with chronic liver disease or in the course of acute hepatic failure. It is characterized by the following criteria (7.) exclusion of an underlying pulmonary or cardiac disease, (2.) increase in the alveolocapillary oxy-... 

Jacqnemln, E., Pariente, D., Fabre, M., Huault, G., Valayer, J., Bernard, O. Pehosis hepatis with initial presentation as acute hepatic failure and intraperitoneal hemorrhage in children. J. Hepatol. 1999 30 1146-1150... 

Katsushima, S., Inokuma, T., Oi, H., Okamura, J., Higashi, T., Takeuchi, R., Hidaka, A., Shigeno, C, lida, Y., Konishi, J. Acute hepatic failure following transcatheter arterial embolization for the treatment of hepatocellular carcinoma. Digestion 1997 58 189-195... 

In acute myeloid leukaemia or lymphatic leukaemia as well as in acute leukaemic episodes in non-Hodgkin lymphoma, involvement of the liver may only be detectable clinically by the presence of hepatomegaly and subicterus. Laboratory parameters usually show slightly elevated transaminase as well as bilirubin values, and distinct cholestasis is occasionally observed. (7) Acute hepatic failure can occur during the course of acute leukaemia, (l, 8,26,65) Histologically, there are massive, yet uniform blast-cell infiltrates these are found mainly within the portal fields in acute lymphatic leukaemia (about 95%) and within the sinusoids in acute myeloid leukaemia (about 75%). Involvement of the liver is of no consequence with regard to the underlying disease and its therapy. Secondary infections require systemic treatment with antibiotics and/or antimycotics. 

Miwa, Y., Kato, M., Moriwaki, H., Okuno, M., Sugihara, J., Ohnishi, H., Yoshida, T., Muto, Y., Nakayama, M., Morioka, Y., Asagi, K. Effects of branched-chain amino acid infusion on protein metabolism in rats with acute hepatic failure. Hepatology 1995 22 291 -296... 

Ward S, Neill EA. Pharmacokinetics of atracurium in acute hepatic failure (with acute renal failure). Br J Anaesth 1983 55(12) 1169-72. 

Two health-care workers exposed to HIV developed severe hypersensitivity reactions to nevirapine one required orthotopic liver transplantation to overcome the complications of acute hepatic failure and coma (14). 

Fulminant hepatic failure occurs in 1-5% of cases of paracetamol overdosage 3-6 days after ingestion (71), with frequent deaths in people who take 20-25 g. There is only a narrow margin between the normal maximum 24-hour dosage and that which can cause liver damage and acute hepatic failure. Undoubtedly, some people are more susceptible than most to paracetamol toxicity, since although 6 g has been reported as toxic in some cases, most toxicity is seen with 12 g upwards (72,73). Nomograms have been developed to show the relation between plasma paracetamol concentrations over time and the risk of a serious outcome (SEDA-18, 94). 

During the past two decades there have been many reports of liver failure resulting in death or transplantation in patients being treated for ADHD with pemoline. However, a descriptive meta-analysis of the existing scientific literature and drug reporting databases showed that current assumptions of the risk of acute hepatic failure posed by pemoline alone are overestimates. 

A 7-year-old boy with Duchenne muscular dystrophy and attention deficit hyperactivity disorder (ADHD) developed acute hepatic failure, with features of autoimmune hepatitis (2). The only medications he had taken were pemoline (56 mg/day) and cjrproheptadine (2 mg/day). Pemoline was withdrawn after 8 months as the presumed cause of his raised transaminases. Two weeks later he developed an altered mental state, jaundice, and encephalopathy. The histological features of the liver and his autoimmune antibody panel were consistent with autoimmune hepatitis. He was treated with corticosteroids and azathioprine and recovered. 

Liver toxicity, if it occurs, is exceedingly rare. Fatal acute hepatic failure was described in a 3-year-old boy (SEDA-21, 78). 

A large body of evidence is available examining the acute toxicity of acetaminophen in animal models. Mice and rats have been widely used to study the toxic effects of acetaminophen. Since the rat is relatively resistant, the mouse has been the most widely used species to study both the mechanisms of acetaminophen toxicity and to examine chemicals that potentiate or protect from the toxicity. Hepatotoxic-ity and nephrotoxicity are the two main effects associated with acute overdose of acetaminophen. Of these, death in most species is due to acute hepatic failure. LD50 values range from 350 to 4500mgkg depending on the species and the route of acetaminophen administration, mice (LD50 350-... 

Pemoline. Pemoline (9), an agent used in treatment of ADHD, has been associated with hepatotoxicity, with the majority of cases occurring in pediatric patients. From its marketing in 1975 up to 1989, 12 cases of acute hepatic failure and six deaths associated with pemoline hepatotoxicity had been reported to the FDA (36). Death generally oc-... 

Hepatic encephalopathy is a metabolic disorder characterized by a wide spectrum of neuropsychiatric dysfunction. It may occur as an acute syndrome in patients with acute hepatic failure from viral or drug-induced hepatitis or as a chronic syndrome associated with liver failure and cirrhosis. 

The diagnosis of hepatic encephalopathy is made on clinical grounds. Plasma ammonia concentrations are rarely helpful, either for diagnosis or for monitoring the patient s disorder normal ammonia concentrations are helpful in excluding hepatic encephalopathy as a cause of cerebral dysfunction. An exception is a patient who presents with acute encephalopathy of unknown cause. Elevated ammonia concentrations in that situation suggest acute hepatic failure or Reye s syndrome. 

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