Cases reported "Liver Failure, Acute"

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1/9. Use of acetylcysteine as the life-saving antidote in amanita phalloides (death cap) poisoning. Case report on 11 patients.

    alpha-amanitin is an amatoxin known to produce deleterious effects on the liver and the kidneys, when circulating in the blood. It is produced by a particular kind of mushroom called amanita phalloides. Therapeutic options employed to treat mushroom intoxication, such as haemodiaperfusion on activated charcoal, high dosages of penicillin g, oral charcoal, etc., very often failed to act properly and liver transplantation (when a graft is available) appeared to be the only solution. In recent years, as suggest by some authors, it has been postulated that the oxidant effects of alpha-amanitin could be counteracted by the use of antioxidants such as silibinin. High dosages of N-acetyl-cysteine (CAS 616-91-1, NAC), already used as antioxidant in paracetamol poisoning, were successfully used in our intensive care Unit (ICU) in the treatment of amanita phalloides poisoning. In the last two years, 11 patients (mean age of 5-72 = 38.5) were treated for amanita phalloides poisoning of various degrees, with a protocol (haemodiaperfusion on activated charcoal, high dosages of penicillin g, etc.) further comprehending NAC (fluimucil). All the patients recovered successfully but one (bearing precedent liver disease) needed liver transplantation. Daily monitoring of liver enzymes, creatinine, coagulation, LDH, blood and urinary alpha-amanitin were used to screen the progresses of the patients.
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ranking = 1
keywords = intoxication
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2/9. Fatal mushroom poisoning caused by amanita virosa in thailand.

    Consumption of toxic mushrooms belonging to the genus amanita frequently leads to severe gastrointestinal distress followed by acute hepatic failure with a fatal outcome. In thailand, valuable information as to the locally prevalent poisonous species, the preferred habitat and the management of suspected victims of intoxication is basically non-existent. We report here 5 cases of fatal poisoning with amanita virosa having occurred in a family residing in the northeast of thailand who as countless others had enjoyed mushroom gathering as a pasttime. Within 4 to 6 days after ingestion of the mushrooms, all had succumbed to acute hepatic failure with subsequent hepatoencephalopathy. Treatment modalities exist in the form of penicillin and silibinin, or thioctic acid administration followed by plasmapheresis. In cases taking a lethal course apparent from the results of liver biochemistry, liver transplantation is clearly indicated. In order to prevent mushroom poisoning altogether, educating the general population to that end certainly presents the method of choice.
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ranking = 1
keywords = intoxication
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3/9. mars procedure as a bridge to combined liver-kidney transplantation in severe chromium-copper acute intoxication: a paediatric case report.

    We describe a case of multi-organ failure (liver-kidney insufficiency and brain oedema) caused by accidental, acute intoxication with a chromium and copper-containing substance, as an example of the introduction of the new extracorporeal procedure mars (molecular adsorbents recirculating system) in a girl 3.5 years old.
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ranking = 5
keywords = intoxication
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4/9. Re-use of a liver allograft; an exceptional opportunity to enlarge the organ donor pool.

    Liver allograft re-use is an exceptional way of enlarging the donor pool. We describe here a case of a re-used liver allograft, originating from an insulin-intoxicated donor and transplanted at first into a recipient presenting with hyperacute liver failure due to paracetamol intoxication. Because the original recipient developed an irreversible cerebral oedema, the allograft was re-implanted electively 55.5 h later into a patient with post-viral C cirrhosis and solitary hepatocarcinoma. Both donor and recipient operations were technically successful; liver function after the second use of the graft was normal.
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ranking = 1
keywords = intoxication
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5/9. Sickle cell crisis and cocaine hepatotoxicity.

    Hepatic dysfunction occurs in up to 10% of patients with sickle cell crisis; however, hepatic failure is quite unusual. cocaine hepatotoxicity has recently been recognized in humans with liver biopsies showing varying patterns of necrosis. Most patients reported with cocaine intoxication have rhabdomyolysis with renal failure, and half of the cases have been fatal. A patient with concomitant sickle cell crisis and cocaine intoxication presented with hepatic failure, coagulopathy, and encephalopathy. Transjugular liver biopsy showed focal areas of confluent necrosis and large areas of collapse. cocaine intoxication should be considered in the differential diagnosis of hepatic failure in patients with sickle cell anemia.
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ranking = 3
keywords = intoxication
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6/9. portal vein arterialization: a new surgical option against acute liver failure?

    survival rates of patients with acute liver failure (ALF) without transplantation are poor. Supporting these patients until an organ becomes available or until their own liver is able to regenerate itself, avoiding transplantation, is a major goal in the treatment of ALF. We report our clinical experience of portal vein arterialization in one case of massive liver necrosis after liver transplantation and in two patients with ALF caused by idiosyncratic drug reaction and mushroom intoxication. portal vein arterialization, at least in two cases, was a turning point in the course of the disease since a close temporal association between surgery and clinical improvement was clearly evident. We believe that this novel approach, which should promote liver regeneration by providing an additional oxygen supply to the liver, may disclose a new possibility in the treatment of ALF and prompt new clinical and experimental research.
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ranking = 1
keywords = intoxication
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7/9. Molecular adsorbent recirculating system--mars as a bridge to liver transplantation in amanita phalloides intoxication.

    A case of a 46-year-old female intoxicated with amanita phalloides was presented. Since constant deterioration of her liver function she was put on the waiting list for urgent liver transplantation. To improve her clinical condition two sessions of Molecular Adsorbent Recirculating System were provided with transient good results. About 72 hours after the mushroom ingestion the patient had undergone liver transplantation. Conclusions: Despite good clinical condition the patients severely poisoned with amanita phalloides should be placed on a waiting list for liver transplantation as early as possible. The Molecular Adsorbent Recirculating System should be introduced as soon as possible after amanita phalloides intoxication. Albumin dialysis may be considered as a bridge for the liver transplantation in patients intoxicated with amanita phalloides.
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ranking = 5
keywords = intoxication
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8/9. Hemophagocytic syndrome and acute liver failure associated with ethylene glycol ingestion: a case report.

    The authors describe a case of accidental ethylene glycol poisoning in an 18-month-old boy who developed hemophagocytic syndrome (HPS). ethylene glycol is a common substance in various antifreeze preparations. Acute ethylene glycol intoxication is a medical emergency that, if not diagnosed correctly and treated aggressively, will lead to serious neurological, cardiopulmonary, and renal dysfunction, and may result in death. The taking of a detailed history, physical examination, and laboratory testing are essential for diagnosis. To the best of the authors' knowledge this is the first case in the literature of a subject who developed HPS after ethylene glycol intoxication.
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ranking = 2
keywords = intoxication
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9/9. Recurrent liver failure with severe rhabdomyolysis after liver transplantation for carbon tetrachloride intoxication.

    Acute liver failure due to intoxication is a rare indication for liver transplantation which a usually has a good prognosis. We herein report the case of a young male, who underwent orthotopic liver transplantation for acute liver failure due to carbon tetrachloride intoxication. Apart from hepatic and renal failure, the patient also developed severe rhabdomyolysis, which has not thus far been described as a toxic effect of this chemical agent. Despite forced hyperventilation, which is known to be the most effective means of eliminating the specifically lipophylic agent, as well as excessive plasma exchange following intravenous administration of fat emulsions, liver failure recurred when blood carbon tetrachloride concentrations were already at non-toxic levels. Retransplantation of the liver together with a kidney was only temporarily successful, since the patient died due to aspergillus sepsis. Based on this experience, we would recommend that whenever possible in patients with carbon tetrachloride intoxication, liver transplant should be delayed until most of the toxic agent has been eliminated in order to prevent fatal graft damage.
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ranking = 7
keywords = intoxication
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