Deutsche medizinische Wochenschrift (1946) · 1999
[Acute liver failure after therapeutic hyperthermia].
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Hammerschmidt S, Wahn H, Langmann P, Scheppach W
Аннотация
HISTORY AND ADMISSION FINDINGS: A 49-year-old women with malignant neoplasia had undergone whole body hyperthermia under sedation to a rectal temperature of 42.5 to 42.7 degrees C for about one hour. She failed to awaken afterwards and was admitted in a coma and transferred to the intensive care unit (ICU). There was slight improvement in consciousness in the following 30 hours.
INVESTIGATIONS: Clinical and laboratory findings gave a constellation indicating acute liver and renal failure (transaminases ca. 1400 U/l, bilirubin 7.27 mg/dl, serum creatinine 3.15 mg/dl, Quick thromboplastin time under 3.5%, antithrombin III 57%, partial thromboplastin time 70.7 s, platelets 23,000/microliter). Other causes of acute liver failure, especially drug effects, and septicaemia were excluded.
TREATMENT AND COURSE: Treatment consisted of infusion of fresh plasma, neomycin and lactulose by mouth, medication to prevent stress ulcer, and total parenteral nutrition which included branched-chain amino acids. The patient regained full consciousness on the regimen and on the 6th day after admission was transferred to an ordinary ward. She was discharged after a further 3 weeks, by which time results of laboratory tests were practically normal.
CONCLUSION: The course of the illness as well as the exclusion of any other cause of the acute liver failure in a patients who, 7 days before whole-body hyperthermia had been induced, had shown no signs of liver disease, makes a causal relationship between the hyperthermia and the described abnormalities highly probable. These serious, not previously reported, side effects of whole-body hyperthermia treatment underline the importance of undertaking this form of treatment only if strictest specific criteria are met.
INVESTIGATIONS: Clinical and laboratory findings gave a constellation indicating acute liver and renal failure (transaminases ca. 1400 U/l, bilirubin 7.27 mg/dl, serum creatinine 3.15 mg/dl, Quick thromboplastin time under 3.5%, antithrombin III 57%, partial thromboplastin time 70.7 s, platelets 23,000/microliter). Other causes of acute liver failure, especially drug effects, and septicaemia were excluded.
TREATMENT AND COURSE: Treatment consisted of infusion of fresh plasma, neomycin and lactulose by mouth, medication to prevent stress ulcer, and total parenteral nutrition which included branched-chain amino acids. The patient regained full consciousness on the regimen and on the 6th day after admission was transferred to an ordinary ward. She was discharged after a further 3 weeks, by which time results of laboratory tests were practically normal.
CONCLUSION: The course of the illness as well as the exclusion of any other cause of the acute liver failure in a patients who, 7 days before whole-body hyperthermia had been induced, had shown no signs of liver disease, makes a causal relationship between the hyperthermia and the described abnormalities highly probable. These serious, not previously reported, side effects of whole-body hyperthermia treatment underline the importance of undertaking this form of treatment only if strictest specific criteria are met.