Aggressive Treatment of Life-Threatening Hypophosphatemia During Recovery From Fulminant Hepatic Failure: A Case Report

2017 ◽  
Vol 33 (6) ◽  
pp. 375-379 ◽  
Author(s):  
Brittany D. Bissell ◽  
Jason E. Davis ◽  
Alexander H. Flannery ◽  
David A. Adkins ◽  
Melissa L. Thompson Bastin
Keyword(s):  
Liver Failure ◽  
Continuous Infusion ◽  
Liver Enzymes ◽  
High Dose ◽  
Fulminant Liver Failure ◽  
Aggressive Approach ◽  
Hepatocyte Regeneration ◽  
Threatening Condition ◽  
Life Threatening ◽  
Safe Approach

Acute liver failure secondary to acetaminophen overdose can be a life-threatening condition, characterized by severe electrolyte derangements. Hepatocyte regeneration is associated with phosphorous utilization and is a known complication of liver recovery following injury. We report the case of profound, life-threatening hypophosphatemia following recovery from acute fulminant liver failure. As the liver enzymes normalized, serum phosphorous levels plummeted. Our patient required an aggressive, individualized phosphorus replacement regimen, which resulted in a continuous infusion of intravenous (IV) sodium phosphate, titrated to a maximum rate of 30 mmol/h or 0.5 mmol/kg/h. The patient required over 400 mmol of total IV and oral phosphorous over the course of 48 hours. An aggressive approach to phosphorous replacement was done safely and effectively. Traditional replacement protocols are not adequate to sustain patients with this degree of hypophosphatemia. This is the first report to utilize a continuous infusion of phosphate with a maximum reported rate (0.5 mmol/kg/h). Our report summarizes a novel and safe approach for clinicians to maximally support these patients through high-dose, continuous infusion phosphorous administration.

scholarly journals A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Bertram K. Woitok ◽  
Shawki Bahmad ◽  
Gregor Lindner
Keyword(s):  
Supportive Care ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Multiorgan Failure ◽  
Heat Stroke ◽  
Exertional Heat Stroke ◽  
Hypoxic Hepatitis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Delayed Referral

Background.Exertional heat stroke is a life-threatening condition often complicated by multiorgan failure. We hereby present a case of a 25-year-old male presenting with syncope after a 10  km run in 28°C outside temperature who developed acute liver failure. Case Presentation. Initial temperature was found to be 41.1°C, and cooling measures were rapidly applied. He suffered from acute renal failure and rhabdomyolysis and proceeded to acute liver failure (ASAT 6100 U/l and ALAT 6561 U/l) due to hypoxic hepatitis on day 3. He did not meet criteria for emergency liver transplantation and recovered on supportive care. Conclusions. Acute liver failure due to heat stroke is a life-threatening condition with often delayed onset, which nevertheless resolves on supportive care in the majority of cases; thus, a delayed referral to transplant seems to be reasonable.

Fulminant liver failure resulting from massive hepatic infarction associated with hemolysis, elevated liver enzymes, and low platelets syndrome

2016 ◽  
Vol 42 (10) ◽  
pp. 1375-1378 ◽  
Author(s):  
Masato Yoshihara ◽  
Michinori Mayama ◽  
Mayu Ukai ◽  
Sho Tano ◽  
Yasuyuki Kishigami ◽  
...  
Keyword(s):  
Liver Failure ◽  
Liver Enzymes ◽  
Fulminant Liver Failure ◽  
Hepatic Infarction ◽  
Elevated Liver Enzymes

scholarly journals Plasma Exchange as a Rescue Therapy for Acute Liver Failure

2021 ◽  
Author(s):  
Nupur B Patel ◽  
Anand Sharma ◽  
Itish Patnaik ◽  
Ashok Kumar
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Plasma Exchange ◽  
Resource Constraints ◽  
Rescue Therapy ◽  
Therapeutic Option ◽  
Liver Function Tests ◽  
Threatening Condition ◽  
Life Threatening

Acute Liver Failure (ALF) is a life-threatening condition and often necessitates Liver Transplantation (LT). However, LT is not available to most patients in developing countries due to resource constraints. Here, authors presents a case of 30-year-old female with ALF and fulfilled the criteria for LT. The aetiology of ALF could not be diagnosed in her. Due to the lack of LT facilities, she was offered plasma exchange as a therapeutic option, which resulted in improvement in sensorium and Liver Function Tests (LFT) {bilirubin, International Normalised Ratio (INR), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT)} over a period of two weeks. She was discharged and was doing well during follow-up. Plasma exchange is a less studied but potential treatment option for ALF when LT is not feasible.

Should Newborns with Refractory Chylothorax Be Tried on Higher Dose of Octreotide?

Neonatology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Geza Vass ◽  
Ria Evans Fry ◽  
Charles C. Roehr
Keyword(s):  
Dose Range ◽  
Optimal Dose ◽  
Lipid Absorption ◽  
Management Approach ◽  
High Dose ◽  
Somatostatin Analogue ◽  
Sustained Reduction ◽  
Threatening Condition ◽  
Life Threatening ◽  
Prolonged Hospital

Chylothorax is a rare but life-threatening condition in newborns, often requiring a prolonged hospital stay. To date, no unified guidance exists for best management approach. Octreotide, a somatostatin analogue, has been used to treat neonatal chylothorax due to its effect on the splanchnic circulation and lipid absorption. It is administered either subcutaneously or intravenously; for the latter, a dose range between 1 and 10 µg/kg/h is most commonly used. However, the optimal dose and way of administration remain unclear. Here, we report 2 newborn cases with large volume chylothorax (>500 mL/day), one with congenital chylothorax and one following a repair of a congenital diaphragmatic hernia (post-operative form). In both cases, a significant and sustained reduction in the volume of evacuated chyle was only seen once the dose of intravenous octreotide was increased to 20 µg/kg/h. We suggest that high-dose octreotide can be considered in seemingly refractory cases of neonatal chylothorax.

scholarly journals Efficacy and safety of liver support devices in acute and hyperacute liver failure: a systematic review and network meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anna Kanjo ◽  
Klementina Ocskay ◽  
Noémi Gede ◽  
Szabolcs Kiss ◽  
Zsolt Szakács ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
Meta Analysis ◽  
Liver Support ◽  
Therapeutic Modalities ◽  
Molecular Adsorbent Recirculating System ◽  
Effective Option ◽  
Threatening Condition ◽  
Life Threatening ◽  
Liver Support Devices

AbstractAcute liver failure (ALF) is a potentially life-threatening condition. Liver support therapies can be applied as a bridging-to-transplantation or bridging-to-recovery; however, results of clinical trials are controversial. Our aim was to compare liver support systems in acute and hyperacute liver failure with network meta-analysis. After systematic search, randomized controlled trials (RCT) comparing liver support therapies in adults with acute or hyperacute liver failure were included. In-hospital mortality was the primary outcome, the secondary outcomes were hepatic encephalopathy and mortality-by-aetiology. A Bayesian-method was used to perform network meta-analysis and calculate surface under the cumulative ranking curve (SUCRA) values to rank interventions. Eleven RCTs were included. BioLogic-DT and molecular adsorbent recirculating system (MARS) resulted in the lowest mortality (SUCRAs: 76% and 73%, respectively). In non-paracetamol-poisoned patients, BioLogic-DT, charcoal hemoperfusion and MARS may be equally efficient regarding mortality (SUCRAs: 53%, 52% and 52%, respectively). Considering hepatic encephalopathy, extracorporeal liver assist device (ELAD) may be the most effective option (SUCRA: 78%). However, in pairwise meta-analysis, there were no statistically significant differences between the interventions in the outcomes. In conclusion, MARS therapy seems to be the best available option in reducing mortality. Further research is needed on currently available and new therapeutic modalities. (CRD42020160133).

scholarly journals Case Report: Pediatric Recurrent Acute Liver Failure Caused by Neuroblastoma Amplified Sequence (NBAS) Gene Mutations

2021 ◽  
Vol 8 ◽  
Author(s):  
Bingxin Jiang ◽  
Fangfei Xiao ◽  
Xiaolu Li ◽  
Yongmei Xiao ◽  
Yizhong Wang ◽  
...  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Gene Mutations ◽  
Kidney Injury ◽  
Compound Heterozygote ◽  
Healthy Children ◽  
Whole Exome ◽  
Threatening Condition ◽  
Chinese Girl ◽  
Life Threatening

Acute liver failure (ALF) in childhood is a rapidly progressive, potentially life-threatening condition that occurs in previously healthy children of all ages. However, the etiology of ~50% of cases with pediatric ALF remains unknown. We herein report a 4-year-old Chinese girl with recurrent ALF (RALF) due to a mutation in the neuroblastoma amplified sequence (NBAS) gene. The patient had suffered from multiple episodes of fever-related ALF since early childhood. She had also suffered from acute kidney injury, hypertension, mild pulmonary hypertension, pleural effusion, and hypothyroidism. A novel compound heterozygote mutation, c.3596G> A (p.C1199Y)/ex.9del (p.216-248del), in the NBAS gene was identified by whole-exome sequencing (WES). The missense mutation c.3596G> A (p. C1199Y) was inherited from her father, and ex.9del (p.216-248del) was inherited from her mother. The patient was managed with intensive treatments, such as renal replacement therapy (CRRT), intravenous antibiotics, and glucose infusion, and was discharged after full recovery. We identified a novel compound heterozygote mutation in the NBAS gene that caused fever-related RALF in a Chinese child, which further expands the mutational spectrum of NBAS.

Severe case of Lemierre syndrome with multiple neurological and ophthalmological sequelae

2021 ◽  
Vol 14 (8) ◽  
pp. e244669
Author(s):  
Alice Liu ◽  
Jemma Taylor ◽  
Monica Slavin ◽  
Steven Tong
Keyword(s):  
Early Recognition ◽  
Surgical Excision ◽  
Severe Case ◽  
Intracranial Extension ◽  
High Dose ◽  
Lemierre Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Right ◽  
Discharge From Hospital

A 56-year-old man was admitted to intensive care with septic shock, multiple facial abscesses and thrombophlebitis of the right internal jugular vein with extensive intracranial extension. A diagnosis of Lemierre syndrome due to Streptococcus anginosus was made and treatment initiated with high-dose ceftriaxone and metronidazole, along with surgical debridement. His admission was complicated by raised intraocular pressures and visual loss requiring bilateral canthotomies. Despite therapeutic anticoagulation with enoxaparin, he also developed an ischaemic basal ganglia infarct. After a prolonged and complex hospital stay, the patient was later readmitted with an intracerebral abscess requiring surgical excision and a second course of antibiotics. This case highlights the value of early recognition of this rare but potentially life-threatening condition, considerations around anticoagulation and antibiotic decisions, and the importance of close multidisciplinary follow-up even after discharge from hospital.

scholarly journals Fulminant myocarditis: use of echocardiography from diagnosis to extracorporeal membrane oxygenation

2020 ◽  
Vol 7 (3) ◽  
pp. K21-K26
Author(s):  
Na Hyun Park ◽  
Hazem Lashin ◽  
Rosalba Spiritoso
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Early Recognition ◽  
Heart Function ◽  
Thrombus Formation ◽  
Fulminant Myocarditis ◽  
High Dose ◽  
List Type ◽  
Membrane Oxygenation ◽  
Threatening Condition ◽  
Life Threatening

Summary Fulminant myocarditis can present with life-threatening arrhythmias and cardiogenic shock due to ventricular failure. The diagnosis of myocarditis usually requires histological and immunological information, as its aetiology may be infectious (viral or non-viral), autoimmune or drug related. The treatment of fulminant myocarditis depends on the underlying cause but usually includes high dose systemic steroids as well as physiological support. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support patients as a bridge to recovery by supporting biventricular function and decompressing the heart. V-A ECMO carries risks and complications of its own such as thrombus formation or bleeding. Different diagnostic modalities, such as transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE), are central to the monitoring of progression of disease and recovery of heart function. This case highlights the importance of early recognition and early support with V-A ECMO in fulminant myocarditis, as well as the role of repeated echocardiography when weaning from physiological support. Learning points: Myocarditis is a life-threatening condition and early recognition of cardiac failure can be assisted with a bedside echocardiogram. Extracorporeal membrane oxygenation is used as a bridging method of treatment for patients with cardiogenic failure in myocarditis but has its own risks related to anticoagulation and the procedure itself. There are currently no standardised guidelines of when to wean a patient off extracorporeal membrane oxygenation, but echocardiography acts as an important guide to detect complications as well as cardiac recovery.

scholarly journals Propofol Infusion Syndrome: A Life Threatening Condition Blunted by Continuous Renal Replacement Therapy

2020 ◽  
Vol 5 (11) ◽  
Keyword(s):  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Case Reports ◽  
Signs And Symptoms ◽  
High Dose ◽  
Short Term ◽  
Propofol Infusion Syndrome ◽  
Threatening Condition ◽  
Life Threatening

Propofol is a common intensive care unit anesthetic which was approved by FDA in 1989. It possesses sedative, anxiolytic, and anticonvulsant properties. Case reports of Propofol related infusion syndrome (PRIS) started in early 1990s. Reported signs and symptoms included acute refractory bradycardia, severe metabolic acidosis, cardiovascular collapse, lactic acidosis, rhabdomyolysis, hyperlipidemia, renal failure, and hepatomegaly. It is associated with both high dose cumulative and short-term infusions. This case report highlights the development of PRIS in a patient admitted to the ICU, symptoms of which were assumed to be blunted because of continuous renal replacement therapy support.

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