Hepatic failure

452 SECTION THREE CLINICAL GUIDE—ACUTE COMPLICATIONS 

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Therapeutic Function Ammonia detoxicant (hepatic failure)... 

Acetaminophen causes few adverse reactions when used as directed on the label or recommended by the primary health care provider. Adverse reactions associated with the use of acetaminophen usually occur with chronic use or when the recommended dosage is exceeded. Adverse reactions to acetaminophen include skin eruptions, urticaria (hives), hemolytic anemia, pancytopenia (a reduction in all cellular components of the blood), hypoglycemia, jaundice (yellow discoloration of the skin), hepatotoxicily (damage to the liver), and hepatic failure (seen in chronic alcoholics taking the drug). 

Hepatic Effects. Hepatic failure was reported in the case of an accidental ingestion of trichloroethylene that led to an acute overdose (Kleinfeld and Tabershaw 1954). In other case studies, blood analyses revealed no hepatic injury in a man who drank several tablespoons of trichloroethylene (Todd 1954) or in women who drank about 20 mL (Morreale 1976) or an unknown quantity (Perbellini et al. 1991). Self-reported liver problems were not increased among persons in the trichloroethylene subregistry who were exposed to trichloroethylene in their drinking water (ATSDR 1994 Burg et al. 1995). 

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

All azole antifungals carry the potential for rash, photosensitivity, and hepatotoxicity. In general, hepatotoxicity is mild and reversible, presenting as asymptomatic increases in liver transaminases. However, fulminant hepatic failure has been reported with itraconazole. Therefore, serial monitoring of liver function... 

Is the patient taking the appropriate dose of each medication Are the doses adjusted for renal or hepatic failure Are the doses adjusted for drug interactions with concomitant medications ... 

Campo, J. V., McNabb, J., Perel, J. M. et al. (2002). Kava-induced fulminant hepatic failure. /. Am. Acad. Child Adoles. Psychiatr., 41, 631-2. 

Baraldi M, Zeneroli ML, Ventura E, Penne A, Pinelli G, Ricci P, Santi M Supersensitivity of benzodiazepine receptor in hepatic encephalopathy due to fulminant hepatic failure in the rat Reversal by a benzodiazepine antagonist. Clin Sci 1984 67 167-175. 

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

Contraindications include renal and hepatic failure coronary, cerebral, or peripheral vascular disease uncontrolled hypertension sepsis and women who are pregnant or nursing. 

The starting and recommended dose of tolcapone is 100 mg three times daily as an adjunct to carbidopa/L-dopa. Its use is limited by the potential for fatal liver toxicity. Strict monitoring of liver function is required, and tolcapone should be discontinued if liver function tests are above the upper limit of normal or any signs or symptoms suggestive of hepatic failure exist. It should be reserved for patients with fluctuations that have not responded to other therapies. 

Soni MG, Mehendale HM. 1993. Hepatic failure leads to lethality of chlordecone-amplified hepatotoxicity of carbon tetrachloride. Fund Appl Toxicol 21 442-450. 

Naora K, Ding G, Hayashibara M, Katagiri Y, Kano Y, Iwamoto K. (1992). Pharmacokinetics of [6]-gingerol after intravenous administration in rats with acute renal or hepatic failure. Chem Pharm Bull (Tokyo). 40(5) 1295-98. 

Clinical chemistry prior to death for both men revealed metabolic acidosis, acute renal and hepatic failure, skeletal muscle necrosis, and damage to other organ systems. Autolysis of viscera prevented complete characterization of lesions associated with mortality from these... 

Albrecht J, Hilgier W, Zielinska M, Januszewski S, Hesselink M, et al. 2000. Extracellular concentrations of taurine, glutamate, and aspartate in the cerebral cortex of rats at the asymptomatic stage of thioacetamide-induced hepatic failure modulation by ketamine anesthesia. Neurochem Res 25(11) 1497-1502. 

Ramirez, P., Parrilla, P., Sanchez Bueno, F., Robles, R., Pons, J.A., Bixquert, V., Nicolas, S., Nunez, R., Alegria, M. S. and Miras, M. (1994). Fulminant hepatic failure after Lepiota poisoning, J. Hepatol., 19, 51-54. 

Symptoms of hepatic failure include accumulation of fluid in the abdomen and lower body leading to ascites, weight loss, muscle wasting, jaundice and anaemia. 

Osmotic laxative effects are also produced by the polyhydric alcohols, mannitol and sorbitol, which unlike glucose cannot be transported through the intestinal mucosa, as well as by the non-hydrolyzable disaccharide, lactubse. Fermentation of lactulose by colon bacteria results in acidification of bowel contents and microfloral damage. Lactulose is used in hepatic failure in order to prevent bacterial production of ammonia and its subsequent absorption (absorbable NH3 nonabsorbable NH4+), so as to forestall hepatic coma. 

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