Indomethacin normalizes intracranial pressure in acute liver failure: A twenty-three-year-old woman treated with indomethacin

✍ Scribed by J O Clemmesen; B A Hansen; F S Larsen

• Publisher: John Wiley and Sons
• Year: 1997
• Tongue: English
• Weight: 128 KB
• Volume: 26
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510260608

✦ Synopsis

In patients with acute liver failure, cerebral herniation is a hepatic encephalopathy grade III developed, and she was listed common cause of death. The present study reports the effect for emergency liver transplantation. Mechanical hyperventilation of indomethacin on four occasions of intracranial hyperten-(PaCO 2 , 3.75 kPa) was instituted, and further treatment consisted sion, in a 23-year old previously healthy woman with severe of glucose, 20%; lactulose, 15 mL 1 3; omeprazole, 40 mg 1 1;

acetaminophen poisoning. During each episode of intracranial and sedation with midazolam, 5 mg/h. Catheters were inserted in hypertension, the patient was treated with 25 mg of indometha radial artery to monitor mean arterial pressure and in the jugular acin, and each time the intracranial pressure normalized. We venous bulb for repeated measurements of venous jugular lactate recommend further controlled studies to determine the exact content. High-volume plasmapheresis was started, i.e., exchange of effect of indomethacin on cerebral blood flow and metabolism 10 L of plasma over 8 hours, 5 and during this procedure an intra- before it is recommended for treatment of intracranial hypercranial pressure monitor (Camino Lab, San Diego, CA) was inserted tension in patients with acute liver failure. (HEPATOLOGY through a parietal burr hole. The patient's condition was hemody- namically stable, with intracranial pressure between 10 and 20 mm 1997;26:1423-1425.) hg and cerebral perfusion pressure between 70 and 80 mm hg. However, kidney function deteriorated and the patient became an-Abbreviations: AVDlac, arteriojugular vein lactate concentration difference.