Acute Fulminant Hepatic Failure in a Woman Treated With Phenytoin and Trimethoprim-Sulfamethoxazole

2000 ◽  
Vol 124 (12) ◽  
pp. 1800-1803 ◽  
Author(s):  
Marius J-M. Ilario ◽  
Jose E. Ruiz ◽  
Constantine A. Axiotis
Keyword(s):  
Liver Injury ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Acute Hepatic Failure ◽  
Hepatic Necrosis ◽  
Rare Occurrence ◽  
Autopsy Findings ◽  
Massive Hepatic Necrosis

Abstract Massive hepatic necrosis following exposure to phenytoin and trimethoprim-sulfamethoxazole is a rare occurrence and to the best of our knowledge has not been reported previously. Acute hepatic failure following administration of trimethoprim-sulfamethoxazole has rarely been seen, and only 4 cases have been well documented pathologically. We report a case of acute liver failure in a 60-year-old woman following ingestion of phenytoin and trimethoprim-sulfamethoxazole concomitantly over a 9-day period. Autopsy findings revealed acute fulminant hepatic failure. This case demonstrates the effects of chemical-chemical interactions in the potentiation of hepatotoxicity of single agents and specifically illustrates the need for discontinuing trimethoprim-sulfamethoxazole in the presence of early liver injury.

Acute Hepatic Failure

2019 ◽  
Author(s):  
Derek J Erstad ◽  
Motaz Qadan
Keyword(s):  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Liver Failure ◽  
Respiratory Distress ◽  
Acute Liver Failure ◽  
Fulminant Hepatic Failure ◽  
Cerebral Edema ◽  
Hepatic Failure ◽  
Distress Syndrome ◽  
Diagnosis And Management

Acute liver failure (ALF) is a rare but highly morbid condition that is optimally managed by a multidisciplinary team of surgeons, hepatologists, and intensivists at a tertiary care center that specializes in liver disorders. ALF is caused by four primary mechanisms, including viral infections (most commonly Hepatitis A and B); toxicity from acetaminophen overdose or other substances; postoperative hepatic failure ; and miscellaneous causes such as autoimmune hepatitis, genetic disorders, or idiopathic etiologies. Unlike chronic liver failure in which the body develops compensatory, protective mechanisms, ALF may be associated with severe multisystem organ involvement, including respiratory distress syndrome, renal failure, and cerebral edema. Fulminant hepatic failure represents a rapidly progressive form of ALF that portends worse prognosis. Prompt diagnosis and management of multisystem organ dysfunction in an intensive care setting is paramount to survival. However, a subset of patients will fail to improve with medical management alone. Early identification of these individuals for emergent transplant listing has been shown to improve outcomes. Multiple predictive models for ALF survival have been developed, which are based on weighted evaluation of clinical and laboratory parameters. These models may be used to facilitate treatment, predict prognosis, and guide transplant listing. In this chapter, we provide an in-depth review these concepts, focusing on the classification, epidemiology, diagnosis, and management of ALF. This review contains 5 tables and 69 references. Key Words: acute liver failure, acute respiratory distress syndrome, coagulopathy, cerebral edema, fulminant hepatic failure, hepatic necrosis, liver transplantation, metabolic disarray, multidisciplinary intensive care, prognostication

Management of acute hepatic failure in the critically ill

2016 ◽  
Author(s):  
Deepak Joshi ◽  
Georg Auzinger
Keyword(s):  
Liver Transplantation ◽  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Acute Hepatic Failure ◽  
Brain Dysfunction ◽  
Hepatic Necrosis ◽  
Multisystem Disorder ◽  
Grade Iii ◽  
Viable Treatment

Acute liver failure occurs in patients with acute hepatic necrosis resulting in hepatic encephalopathy, jaundice and coagulopathy. Acute liver failure is a multisystem disorder. The management is initially supportive. Intravenous N-acetylcysteine is recommended for all patients. Brain dysfunction is common. Elective intubation is recommended for all patients who develop Grade III hepatic encephalopathy. Liver transplantation is an appropriate and viable treatment for acute liver failure. Early and safe transfer to a transplant centre for transplant assessment is advised.

Acute Hepatic Failure

2019 ◽  
Author(s):  
Derek J Erstad ◽  
Motaz Qadan
Keyword(s):  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Liver Failure ◽  
Respiratory Distress ◽  
Acute Liver Failure ◽  
Fulminant Hepatic Failure ◽  
Cerebral Edema ◽  
Hepatic Failure ◽  
Distress Syndrome ◽  
Diagnosis And Management

Acute liver failure (ALF) is a rare but highly morbid condition that is optimally managed by a multidisciplinary team of surgeons, hepatologists, and intensivists at a tertiary care center that specializes in liver disorders. ALF is caused by four primary mechanisms, including viral infections (most commonly Hepatitis A and B); toxicity from acetaminophen overdose or other substances; postoperative hepatic failure ; and miscellaneous causes such as autoimmune hepatitis, genetic disorders, or idiopathic etiologies. Unlike chronic liver failure in which the body develops compensatory, protective mechanisms, ALF may be associated with severe multisystem organ involvement, including respiratory distress syndrome, renal failure, and cerebral edema. Fulminant hepatic failure represents a rapidly progressive form of ALF that portends worse prognosis. Prompt diagnosis and management of multisystem organ dysfunction in an intensive care setting is paramount to survival. However, a subset of patients will fail to improve with medical management alone. Early identification of these individuals for emergent transplant listing has been shown to improve outcomes. Multiple predictive models for ALF survival have been developed, which are based on weighted evaluation of clinical and laboratory parameters. These models may be used to facilitate treatment, predict prognosis, and guide transplant listing. In this chapter, we provide an in-depth review these concepts, focusing on the classification, epidemiology, diagnosis, and management of ALF. This review contains 5 tables and 69 references. Key Words: acute liver failure, acute respiratory distress syndrome, coagulopathy, cerebral edema, fulminant hepatic failure, hepatic necrosis, liver transplantation, metabolic disarray, multidisciplinary intensive care, prognostication

scholarly journals Two sides of one coin: massive hepatic necrosis and progenitor cell-mediated regeneration in acute liver failure

2015 ◽  
Vol 6 ◽  
Author(s):  
Hong-Lei Weng ◽  
Xiaobo Cai ◽  
Xiaodong Yuan ◽  
Roman Liebe ◽  
Steven Dooley ◽  
...  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Progenitor Cell ◽  
Hepatic Necrosis ◽  
Massive Hepatic Necrosis ◽  
Two Sides

Plasmapheresis in Acute Liver Failure

1986 ◽  
Vol 9 (6) ◽  
pp. 433-438 ◽  
Author(s):  
J.G. Freeman ◽  
K. Matthewson ◽  
C.O. Record
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Hepatic Failure ◽  
Serum Bilirubin ◽  
Hepatic Coma ◽  
Acute Hepatic Failure ◽  
Plasma Ammonia ◽  
Coma Grade ◽  
Better Than

A series of 9 patients with acute hepatic failure and Grade IV hepatic coma received daily plasmapheresis until they recovered or death ensued. Of the nine, seven (77%) showed an improvement in coma grade and five (55%) survived to leave hospital. Plasmapheresis significantly decreased serum bilirubin, asparate aminotransferase and plasma ammonia concentrations. Survival following plasmapheresis appeared substantially better than in a non randomized group of similar patients not plasmapheresed. The simplicity of the procedure, biochemical improvements observed and apparent efficacy, suggest that further evaluation of the technique as a means of providing temporary hepatic support is indicated.

scholarly journals Paradoxical Role of Matrix Metalloproteinases in Liver Injury and Regeneration after Sterile Acute Hepatic Failure

Cells ◽  
2018 ◽  
Vol 7 (12) ◽  
pp. 247 ◽  
Author(s):  
Débora Alvarenga ◽  
Matheus Mattos ◽  
Mateus Lopes ◽  
Sarah Marchesi ◽  
Alan Araújo ◽  
...  
Keyword(s):  
Liver Injury ◽  
Matrix Metalloproteinases ◽  
Hepatic Failure ◽  
Acute Hepatic Failure ◽  
Neutrophil Infiltration ◽  
Hepatic Necrosis ◽  
Pharmacological Intervention ◽  
Neutrophil Accumulation ◽  
Drug Induced

Acetaminophen (APAP) poisoning is one of the leading causes of acute hepatic failure and liver transplantation is often the only lifesaving alternative. During the course of hepatocyte necrosis, an intense accumulation of neutrophils is often observed within the liver microenvironment. Despite the classic idea that neutrophil accumulation in tissues causes collateral tissue damage, there is a growing body of evidence showing that neutrophils can also orchestrate the resolution of inflammation. In this work, drug-induced liver injury was induced by oral administration of APAP and pharmacological intervention was made 12 h after this challenge. Liver injury and repair kinetics were evaluated by a novel combination of enzyme quantifications, ELISA, specific antagonists of neutrophil enzymes and confocal intravital microscopy. We have demonstrated that neutrophil infiltration is not only involved in injury amplification, but also in liver tissue repair after APAP-induced liver injury. In fact, while neutrophil depletion led to reduced hepatic necrosis during APAP poisoning, injury recovery was also delayed in neutropenic mice. The mechanisms underlying the neutrophil reparative role involved rapid degranulation and matrix metalloproteinases (MMPs) activity. Our data highlights the crucial role of neutrophils, in particular for MMPs, in the resolution phase of APAP-induced inflammatory response.

scholarly journals Liver transplantation for acute liver failure: a 5 years experience

2008 ◽  
Vol 45 (3) ◽  
pp. 192-194 ◽  
Author(s):  
Cyntia Ferreira Gomes Viana ◽  
Tarciso Daniel Santos Rocha ◽  
Fernanda Paula Cavalcante ◽  
José Telmo Valença Jr. ◽  
Gustavo Rêgo Coelho ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Intensive Care ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Waiting Time ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Blood Type ◽  
Group A ◽  
Group B

BACKGROUND: Fulminant hepatic failure carries a high morbidity and mortality. Liver transplantation has markedly improved the prognosis of patients with fulminant hepatic failure. AIM: To evaluate the outcome of 20 patients with acute liver failure and indication for liver transplantation. METHODS: A retrospective review of 20 patients with acute liver failure and indication for liver transplantation was performed. Patients were divided into two groups: group A with 12 patients who underwent liver transplantation and group B with 8 patients who did not receive liver transplantation. Both groups were analyzed according to age, sex, ABO blood type, etiology of acute liver failure, time on list until transplantation or death, and survival rates. Group A patients were additionally analyzed according to preoperative INR, AST, and ALT peak values and MELD (Model for End-stage Liver Disease) scores; intraoperative red blood cells and plasma transfusion and cold ischemia time; postoperative lenght of intensive care unit and hospital stay, and needed for dialysis. RESULTS: Group A: there were four men and eight women with an average age of 24.6 years. The average liver waiting time period was 3.4 days and MELD score 36. Seven patients are alive with good hepatic function at a medium follow-up of 26.2 months. The actuarial survival rate was 65.2% at 1 year. Group B: There were two men and six women with an average age of 30.9 years. The mean waiting time on list until death was 7.4 days. All patients died while waiting for a liver donor. CONCLUSION: Despite the improvements in intensive care management, most patients with acute liver failure and indication for liver transplantation ca not survive long without transplant. Liver transplantation is potentially the only curative modality and has markedly improved the prognosis of those patients.

scholarly journals Etiology, clinical presentation, and outcome of children with fulminant hepatic failure: Experience from a tertiary center in Pakistan

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Sidra Talat ◽  
Sabeen Abid Khan ◽  
Nismat Javed ◽  
Munir Iqbal Malik
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Clinical Presentation ◽  
International Normalized Ratio ◽  
Common Symptom ◽  
Creative Commons ◽  
Tertiary Center ◽  
Failure Experience

Objectives: To determine etiologies, clinical presentations and outcomes of children with fulminant hepatic failure in the first liver transplant center of Pakistan. Methods: It was a retrospective, observational study, conducted in Paediatric Gastroenterology Department of Shifa International Hospital. Patients between one month to 16 years were included who fulfilled the Pediatric Acute Liver Failure study group (PALFSG) definition of acute liver failure as biochemical evidence of liver injury with no known co-existing chronic liver disease, coagulopathy not corrected by vitamin K, an International Normalized Ratio (INR) greater than 1.5 if the patient has encephalopathy, or greater than 2.0 if the patient does not have encephalopathy. The data collected was recorded on a self-constructed proforma after IRB approval. Results: There were 28 patients in the study which ncluded 17 males and 11 females with a mean age of 72.86±52.50 months. The most common etiologies were Hepatitis A (29%) in isolation or co-infection with Wilson Disease, typhoid fever. It was followed by seronegative hepatitis (29%). Majority (64%) had acute presentation (7 to 28 days), jaundice (82%) being the most common symptom. Severity of encephalopathy was significantly associated with outcome (p=0.02). There were 6 (21%) patients who succumbed to death. Conclusions: The study highlights infective diseases as the predominant etiology causing fulminant liver failure in children. Our study highlights lower mortality in children doi: https://doi.org/10.12669/pjms.36.6.2375 How to cite this:Talat S, Khan SA, Javed N, Malik MI. Etiology, clinical presentation, and outcome of children with fulminant hepatic failure: Experience from a tertiary center in Pakistan. Pak J Med Sci. 2020;36(6):---------.   doi: https://doi.org/10.12669/pjms.36.6.2375 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Wilsons Disease Presenting as Acute Fulminant Hepatic Failure

2021 ◽  
Vol 10 (16) ◽  
pp. 1185-1186
Author(s):  
Kolluru Karthik Raja
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Wilson’S Disease ◽  
Genetic Disorder ◽  
Young Male ◽  
Copper Metabolism ◽  
Wilson's Disease ◽  
Heavy Metal Accumulation

Wilson’s disease (WD) is a genetic disorder characterised by mutations in copper metabolism. Adenosine triphosphate (ATPase) ATP7B gene is responsible for disturbance in copper metabolism that leads to accumulation of copper mainly in liver and also in extra hepatic organs (like brain, cornea, heart and kidney).1 Heavy metal accumulation in brain (mainly in basal ganglia) leads to neuropsychiatric manifestations.2 Kayser Fleischer (KF) ring is golden brown ring distributed along the periphery of cornea. It is due to abnormal deposition of copper in the Descemet’s membrane of cornea. Kayser Fleischer (KF) ring is a pathognomonic sign of Wilson’s disease. Fulminant hepatic failure can be the first presentation of WD. Patients presenting with fulminant Wilson’s disease (FWD) clinically present as acute liver failure with encephalopathy and coagulopathy. The mortality of patients is high and orthotropic liver transplantation is the only option, which has been shown effective in patients with Fulminant Wilson’s disease.3 We are report a case of a young male who presented as acute liver failure first time in life and later was diagnosed as FWD.

Peritoneal Dialysis in Fulminant Hepatic Failure

1986 ◽  
Vol 6 (4) ◽  
pp. 199-202 ◽  
Author(s):  
Robert A. Mactier ◽  
James W. Dobbie ◽  
Ramesh Khanna
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Hepatic Necrosis ◽  
Hepatic Regeneration ◽  
Liver Support ◽  
Rapid Exchange ◽  
Massive Hepatic Necrosis ◽  
Level Of Consciousness

None of the modes of temporary liver support seems to improve survival in fulminant hepatic failure complicated by “grade four” coma. The authors assessed the efficacy of rapid exchange peritoneal dialysis in five consecutive patients with fulminant hepatic failure and grade four coma. Four had concurrent acute renal failure and the prognosis for combined hepatic and renal failure is extremely poor irrespective of mode of therapy. Despite this poor prognosis, three of the five recovered completely, four regained consciousness during the initial peritoneal dialysis and the level of consciousness improved during six of 10 periods of peritoneal dialysis. Two of these patients died two weeks after beginning peritoneal dialysis; and in both autopsy showed massive hepatic necrosis and no evidence of hepatic regeneration. These preliminary results compare favorably with those of hemoperfusion in grade four coma. We conclude that rapid exchange peritoneal dialysis offers a number of theoretical advantages over hemo perfusion and merits further evaluation in the management of fulminant hepatic failure.

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