An Analytical Study on Acute Liver Injury in Patients Caused by Classic Heat stroke

Heat Stroke is a kind of medical emergency that can cause severe dehydration and neurological changes as a result multi-organ injuries or failure could be possible. Heat strokes occur when the body temperature exceeds 40 0C due to external heat and humidity. The liver is widely affected by heatstroke that’s why taking care of patients suffering from heatstroke is very important. Various studies have been reported in the literature regarding acute liver failure but none of the studies discussed acute liver failure during the hospital stay. Patients during their hospital stay will have a higher risk of mortality due to heatstroke. In this paper, an analytical study has been done on admitted patients to a government hospital in India. These patients are suffered from heatstroke from April 2007 to September 2011 and a second time period from July 2018 to September 2019. The sample includes 60 patients with 58 (97%) males having a totaled number of 12 fatalities. The observed International Normalized ratio (INR) parameter is greater than 1.6 and no increased mortality has been noticed, aspartate aminotransferase (AST), as well as alanine aminotransferase (ALT) levels, were not associated with an increased mortality rate.

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Acute Liver Failure in Patients with Classic Heat Stroke

International Journal of Medical Students ◽

10.5195/ijms.2020.442 ◽

2020 ◽

Vol 8 (2) ◽

pp. 111-113

Author(s):

Jeremy J. Hernández-Ríos ◽

Fátima María Martínez-González ◽

Luz A. Gutiérrez-Bañales ◽

J. Andrés Beltrán-López ◽

Hiram J. Jaramillo-Ramírez

Keyword(s):

Mortality Rate ◽

Liver Failure ◽

Acute Liver Failure ◽

Analytical Study ◽

Heat Stroke ◽

Primary Objective ◽

Severe Dehydration ◽

Risk Of Mortality ◽

Neurological Alterations ◽

Second Period

Background: Classic heat stroke is defined by a core temperature greater than 40° C, severe dehydration and neurological alterations. Patients with liver disease due to heat stroke have been described, mostly by exercise. Hepatic failure is defined as the presence of a coagulopathy accompanied by any degree of hepatic encephalopathy. The primary objective of the study lies in the fact that patients who developed acute liver failure during their hospital stay had a higher risk of mortality. Methods: A retrospective, analytical study of patients admitted to the General Hospital of Mexicali who suffered from classic heat stroke from March 2006 through August 2010, and a second period from June 2018 to August 2019. Results: Fifty patients were recruited, the group included 48 (96%) male, with a total of 10 fatalities, representing 20%. INR greater than 1.5, AST and ALT levels were not related to an increased mortality rate. Conclusion: Neither transaminase levels, nor liver failure, were related to a higher mortality rate in this cohort of patients with classic heat stroke.

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Clinical features, laboratory characteristics and outcome of patients with drug-induced acute liver failure

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20191168 ◽

2019 ◽

Vol 6 (2) ◽

pp. 515

Author(s):

Tauseef Nabi ◽

Nadeema Rafiq ◽

Imran Jamil ◽

Quratul Ain Arifa

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Hospital Stay ◽

Clinical Features ◽

Geographical Area ◽

Length Of Hospital Stay ◽

Medical Emergency ◽

Rapid Progression ◽

Middle Aged ◽

Drug Induced

Background: Acute liver failure (ALF) is a rare medical emergency. Its rapid progression and high mortality demand early diagnosis and expert management. Drug-induced ALF (DI-ALF) remains the uncommon cause of ALF in India. Clinical and etiological profile varies with geographical area and time. A prospective study of DI-ALF was carried with the aim to determine the clinical features, laboratory characteristics, outcome and hospital course.Methods: A total of 15 patients with a diagnosis of DI-ALF were included in the study. The variables evaluated were demographic, signs and symptoms, biochemical parameters [bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time (PT), internal normalization ratio (INR) etc.], outcome and course during hospitalization.Results: Out of 15 DI-ALF patients, 12 had Anti-tuberculosis therapy (ATT) induced ALF and 3 patients had ayurvedic induced ALF. Majority of the patients were females (73.3%) and middle-aged (42.60±14.30 years). Coma grade at the time of admission showed that majority of patients (66.8%) had grade I and II encephalopathy. Depending on the pattern of liver injury, hepatocellular pattern was most common (53.3%) followed by mixed and cholestatic pattern. 40% of patients died with DI-ALF complications of which ATT induced ALF contributed 41.7%. Mean AST was more increased as compared to ALT. Development of ascites (P = 0.030) and mannitol use (P = 0.025) was significantly more common in non survived group than survived group. Length of hospital stay was significantly more in non survived group than survived group (P = 0.009).Conclusions: ATT was the class of drugs most frequently associated with DI-ALF. DI-ALF disproportionately affected middle-aged women. Most DILI ALF patients had hepatocellular injury pattern. 40% of patients died with DI-ALF complications. Development of ascites, mannitol use and length of hospital stay was significantly more in non survived group than survived group.

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A Case of Exertional Heat Stroke Complicated by Hypoxic Hepatitis

Case Reports in Emergency Medicine ◽

10.1155/2020/8724285 ◽

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.

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Exertional heat stroke associated with acute liver failure in a young refugee. Implications in the era of social-economic crisis

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-302 ◽

2019 ◽

Vol 28 (3) ◽

pp. 364-364

Author(s):

Dimitrios S. Politis ◽

Gerasimos Baltagiannis ◽

Nikolaos Tzampouras ◽

George N Kalambokis ◽

Vasileios Koulouras ◽

...

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Economic Crisis ◽

Social Economic ◽

Heat Stroke ◽

Exertional Heat Stroke

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Hemostatic Balance in Pediatric Acute Liver Failure: Epidemiology of Bleeding and Thrombosis, Physiology, and Current Strategies

Frontiers in Pediatrics ◽

10.3389/fped.2020.618119 ◽

2020 ◽

Vol 8 ◽

Author(s):

Yonca Bulut ◽

Anil Sapru ◽

Gavin D. Roach

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Cell Activation ◽

Protein S ◽

Bleeding Risk ◽

International Normalized Ratio ◽

Clinical Syndrome ◽

Low Grade ◽

Endothelial Cell Activation ◽

Pediatric Acute Liver Failure

Pediatric Acute Liver Failure (PALF) is a rapidly progressive clinical syndrome encountered in the pediatric ICU which may rapidly progress to multi-organ dysfunction, and on occasion to life threatening cerebral edema and hemorrhage. Pediatric Acute Liver Failure is defined as severe acute hepatic dysfunction accompanied by encephalopathy and liver-based coagulopathy defined as prolongation of International Normalized Ratio (INR) >1.5. However, coagulopathy in PALF is complex and warrants a deeper understanding of the hemostatic balance in acute liver failure. Although an INR value of >1.5 is accepted as the evidence of coagulopathy and has historically been viewed as a prognostic factor of PALF, it may not accurately reflect the bleeding risk in PALF since it only measures procoagulant factors. Paradoxically, despite the prolongation of INR, bleeding risk is lower than expected (around 5%). This is due to “rebalanced hemostasis” due to concurrent changes in procoagulant, anticoagulant and fibrinolytic systems. Since the liver is involved in both procoagulant (Factors II, V, IX, XI, and fibrinogen) and anticoagulant (Protein C, Protein S, and antithrombin) protein synthesis, PALF results in “rebalanced hemostasis” or even may shift toward a hypercoagulable state. In addition to rebalanced coagulation there is altered platelet production due to decreased thrombopoietin production by liver, increased von Willebrand factor from low grade endothelial cell activation, and hyperfibrinolysis and dysfibrinogenemia from altered synthetic liver dysfunction. All these alterations contribute to the multifactorial nature of coagulopathy in PALF. Over exuberant use of prophylactic blood products in patients with PALF may contribute to morbidities such as fluid overload, transfusion-associated lung injury, and increased thrombosis risk. It is essential to use caution when using INR values for plasma and factor administration. In this review we will summarize the complexity of coagulation in PALF, explore “rebalanced hemostasis,” and discuss the limitations of current coagulation tests. We will also review strategies to accurately diagnose the coagulopathy of PALF and targeted therapies.

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A case of cryptogenic pseudocirrhosis causing acute liver failure: when clinic and radiology work together

Italian Journal of Medicine ◽

10.4081/itjm.2019.1129 ◽

2019 ◽

Vol 13 (2) ◽

pp. 121-123

Author(s):

Martina Finocchi ◽

Ombretta Para ◽

Giacomo Zaccagnini ◽

Lorenzo Corbo ◽

Lucia Maddaluni ◽

...

Keyword(s):

Breast Cancer ◽

Liver Failure ◽

Acute Liver Failure ◽

Systemic Chemotherapy ◽

Acute Liver Injury ◽

Metastatic Breast ◽

International Normalized Ratio ◽

Caudate Lobe ◽

Oncologic Patients ◽

Liver Changes

It is known that a wild spectrum of hepatic manifestations can be common presentations of metastatic breast cancer. Pseudocirrhosis pattern has been often described as almost always secondary to systemic chemotherapy and it is defined by morphological liver changes that mimic cirrhosis including capsular retraction, nodularity, parenchyma atrophy and caudate lobe, radiologically identifiable. Acute liver injury is an occasional complication in oncologic patients, and it outlines an organ failure when there is evidence of encephalopathy and coagulopathy (international normalized ratio >1.5) in the absence of pre-existing liver disease, with an illness of <26 weeks duration. The two most common etiologies are leukemia/lymphoma followed by breast cancer but also in this case, liver is involved almost always after chemotherapy, hormonotherapy or radiotherapy. Here we present a case of rapid evolving acute liver failure presented as cryptogenic pseudocirrhosis without any evidence of primitive breast cancer but an incidental demonstration.

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