Liver failure, acute patient case

Liver It is important to consider paracetamol dosage reduction in patients with low body weights or with other susceptibility factors for hepatotoxicity. In two adults weighing 30 and 44 kg (body mass indices 12 and 17 kg/m ) acute liver failure (in one case with a fatal outcome) occurred after administration of paracetamol 4 g/day [IS ]. 

All cases of acute liver failure related to the use of lovastatin have been reviewed, and probably the frequency is similar to the background rate. This suggests that periodic monitoring of alanine transaminase in these patients would be burdensome and expensive (24). 

While hepatic encephalopathy is nearly always found in acute liver failure, it can only be expected in some 25-40% of patients with a portosystemic shunt. When these two preconditions coincide, as in the case of liver cirrhosis, manifest hepatic encephalopathy is witnessed in 30-50% of patients and a subclinical course of disease in 50-70%. In other words, the frequency, the degree of severity and the course taken by HE depend on the underlying conditions. 

In endogenous hepatic coma (= due to loss of liver parenchyma), which in most cases develops from an existing chronic liver disease ( acute on chronic ), the prognosis is better than for acute liver failure, but nevertheless remains extremely poor. According to the information available in the relevant literature, 10-20% of patients die in stage I and 40-50% in stage II in stages III and IV, lethality is 80-90%, the same rate as in acute liver failure, (see chapter 20)... 

Acute liver failure is a rare occurrence. It is estimated that approx. 5 cases are found out of 6,000 hospital admissions (in the USA a total of ca. 2000 patients per year, in Germany ca. 150). However, there can be wide variations in frequency due to the effect of regional differences on the individual aetiology of this disease. The causes of acute liver failure are numerous and multiform. Diabetes mellitus is an extremely high risk factor... 

Pancreatitis The frequency of hyperamylasaemia is reported to be 55% of patients with acute liver failure in 20 — 30% of cases, pancreatitis could be identified clinically and sonographically. The cause is multifactorial. 

Liver transplantation is indicated in the terminal stage of cirrhosis, in acute liver failure and, above all, for nonresponders to long-term therapy. The 5-year survival rate is 85-90%. Determining the right time for transplantation is problematical, however. All possibilities of medication should have been exploited first. It is remarkable that AIH reoccurs in the transplanted liver in 7-10% of cases after 1 year and in 65-70% of cases after 5 years. In patients with HLA-DR3, there was no evidence of recurrence anymore. (13) Following transplantation, the autoantibodies may disappear from the serum. (12, 22, 27, 57, 62, 75, 80, 105)... 

The patient is suspected to be suffering from HCC when the subjective complaints continue to worsen and when an increase in complaints, which may occur quite abruptly in some cases, cannot be explained by the progression of cirrhosis. Most patients are affected by pain radiating into the right side of the back or into the right shoulder and neck area. This is due to an irritation of the phrenic nerve caused by expansion of the tumour towards or even into the liver capsule. Anorexia is more pronounced. Occasionally, the course of HCC is acute, resembling liver failure or liver abscess. 

Acute renal tubular damage occurs in association with the liver damage, together with muscle necrosis and hyperkalemia. The muscle necrosis, as demonstrated at autopsy in fatal cases (82), can itself exacerbate the severe electrolyte derangement, particularly marked hyperkalemia, that occurs in liver failure. The measurement of serum concentrations of coagulation factors V (below 10%) and VIII (VIII/V ratio over 30) can have predictive value and can thus be helpful in selecting patients who require hver transplantation (SEDA-17, 99). 

Amphetamines have also been associated with a syndrome of acute kidney injury and rhabdomyolysis. Several series have described patients following intravenous injection of methamphetamine or phenmetrazine who presented with hyperactivity, fever, chills, sweats, abdominal cramps, diarrhea, and hypotension [177,178]. The patients have developed acute kidney injury which is usually oliguric and associated with classic rhabdomyolysis, similar to cases of cocaine-induced rhabdomyolysis. Several patients have had disseminated intravascular coagulation and liver function abnormalities as well. Methamphetamine abuse has also been associated with accelerated hypertension, unexplained chronic renal failure, acute lead poisoning (a common reagent used in its production utilizes lead acetate) and at least one case of biopsy proven interstitial nephritis the latter patient responded to intravenous corticosteroids but whether the nephritis was truly due to amphetamines remains unproven [179]. 

Adverse drug reactions (ADRs) are a major cause of patient morbidity and a significant cause of patient mortality (Lazarou et al. 1998 Pirmohamed et al. 1998). There are many types of ADRs, affecting every organ in the body (Table 1). However, drug-induced liver injury (DILI) is the most frequent reason for the withdrawal of an approved drug from the market (Temple and Himmel 2002), and it accounts for approximately 50% of all acute liver failure cases (Kaplowitz 2001 Lee 2003 Ostapowicz 2002) and 15% of all liver transplantations in the United States (Russo et al. 2004). 

A case series describes 10 incidences of acute hepatitis that were observed over a 2-year period. Cholestasis was observed in 5 of the 10 patients, and in 7 of the 10 cases, the hepatitis was characterized as drug-induced. No liver failure occurred in any of the patients, and cessation of celandine resulted in resolution of hepatitis. Use of celandine was from 1 to 9 months. Prescription and nonprescription drugs and herbal supplements were also being used in some cases, including thyroxine (2 patients), iodide (2 patients), estradiol (2 patients), and amitriptyline (1 patient) (Benninger et al. 1999). Cholestatic hepatitis has been... 

Instead, artificial liver application is relatively more recent and, in any case, it is a short-term bridge therapy that applies to a few cases of acute liver failure. Nevertheless, the correct application of this hemopurification procedure is vital for liver regeneration - the liver, unfike the kidney, is able to regenerate - implying complete patient recovery. For this reason, the bioartificial liver is a key solution to improve the probability of patient recovery, since the liver biological functions other than toxin removal are essential for the whole body health. 

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