scholarly journals Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Amanda M. Spillane ◽  
Jenica L. Haraschak ◽  
Maureen A. McMichael
Keyword(s):  
Hepatic Encephalopathy ◽  
Lipid Emulsion ◽  
Reference Interval ◽  
Ammonia Concentration ◽  
Acute Onset ◽  
Portosystemic Shunt ◽  
Dramatic Improvement ◽  
Intravenous Lipid Emulsion ◽  
Life Threatening ◽  
Patient’S History

A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of >50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 μg/dL (reference interval, RI: 24–36 μg/dL) and decreased to 194.1 μg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.

Successful reversal of life threatening cardiac effect following dosulepin overdose using intravenous lipid emulsion

2011 ◽  
Vol 49 (4) ◽  
pp. 337-339 ◽  
Author(s):  
Soeren Boegevig ◽  
Anders Rothe ◽  
Jacob Tfelt-Hansen ◽  
Lotte C.G. Hoegberg
Keyword(s):  
Lipid Emulsion ◽  
Cardiac Effect ◽  
Intravenous Lipid Emulsion ◽  
Life Threatening

scholarly journals Case Report: Drug induced hyperkalemia presenting as acute flaccid quadriparesis

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 737 ◽  
Author(s):  
Santhosh Narayanan ◽  
Divya Prakash
Keyword(s):  
Case Report ◽  
Cardiac Disease ◽  
Acute Onset ◽  
Flaccid Paralysis ◽  
Dramatic Improvement ◽  
Drug Induced ◽  
Emergency Condition ◽  
Life Threatening

Hyperkalemia is a life-threatening dyselectrolytemia that commonly affects cardiac conductivity and contractility. Ascending paralysis affecting the extremities associated with hyperkalemia is not commonly seen. Here we report a case of flaccid quadriparesis in a patient who was taking potassium sparing diuretic for cardiac disease. An electrocardiogram showed typical signs of hyperkalemia. The patient was administered antihyperkalemic measures, which led to a dramatic improvement in symptoms. Hyperkalemic paralysis is a completely reversible emergency condition and should always be considered when dealing with acute onset flaccid paralysis.

scholarly journals Recanalisation of a congenital extrahepatic portosystemic shunt previously attenuated with cellophane banding in a cat

2018 ◽  
Vol 4 (2) ◽  
pp. 205511691879571
Author(s):  
James Crowley ◽  
Timothy Foo ◽  
Lara Boland ◽  
Laurencie Brunel
Keyword(s):  
Hepatic Encephalopathy ◽  
Bile Acids ◽  
Clinical Signs ◽  
Reference Interval ◽  
Portosystemic Shunt ◽  
Liver Size ◽  
Long Term Follow Up ◽  
Stimulation Tests ◽  
Congenital Extrahepatic Portosystemic Shunt ◽  
Liver Changes

Case summary A congenital extrahepatic portosystemic shunt was attenuated with commercial roll cellophane banding in a cat and postoperative liver changes were monitored using CT angiography (CTA). The patient clinically improved after cellophane banding, characterised by resolution of hepatic encephalopathy, weight gain, reference interval (RI) bile acid stimulation tests, as well as CTA-documented increased liver size, increased hepatic vasculature and shunt attenuation. Six months later the cat re-presented with recurrence of clinical signs and increased bile acids. CTA confirmed recanalisation of the shunt. Shunt attenuation was repeated using pure cellophane banding and nearly complete closure of the shunt was later documented by CTA. Seven months later, recanalisation was again documented via CTA and associated with clinical signs and increased bile acids. Complete ligation of the shunt was achieved using a polypropylene ligature and a titanium ligating clip. At long-term follow-up, the cat was clinically well, and bile acids and biochemistry were within the RIs. Relevance and novel information This is the first report of CTA-documented recanalisation of an extrahepatic portosystemic shunt previously attenuated with cellophane banding. Recanalisation should be considered as a differential for recurrence of hepatic encephalopathy following cellophane banding.

scholarly journals Successful Reversal of Chronic Incapacitating Post-TIPS Encephalopathy by Balloon Occlusion of the Stent

1994 ◽  
Vol 8 (2) ◽  
pp. 75-80 ◽  
Author(s):  
Daphna Fenyves ◽  
Michel P Dufresne ◽  
Jean Raymond ◽  
Michel Lafortune ◽  
Bernard Willems ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Balloon Occlusion ◽  
Portosystemic Shunt ◽  
Portal System ◽  
Variceal Hemorrhage ◽  
General Anesthetic ◽  
Portal Flow ◽  
Life Threatening ◽  
Intrahepatic Portosystemic Shunt ◽  
A New Technique

Transjugular intrahepatic portosystemic shunt (TIPS) placement is a new technique allowing decompression of the portal system without the need for abdominal surgery or general anesthetic. This promising procedure appears safe, and is being evaluated in the context of life threatening uncontrollable variceal hemorrhage as well as ascites refractory to medical treatment. Following TIPS, portal flow diversion is associated with hepatic encephalopathy in up to 25% of patients. This is most often mild and treatable but may become uncontrollable, incapacitating and even life threatening in up to 3 to 5% of cases. The authors present two patients in whom such life threatening encephalopathy and stupor was reversed by transjugular balloon occlusion of the TIPS.

Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension

2015 ◽  
Vol 24 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Jiannan Yao ◽  
Li Zuo ◽  
Guangyu An ◽  
Zhendong Yue ◽  
Hongwei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Pressure Gradient ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meld Score ◽  
Portosystemic Shunt ◽  
Portal Flow ◽  
Intrahepatic Portosystemic Shunt

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words:  –  –  – .

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