title: Treatment of fulminant hepatic failure with infusions of Co-factors and mannitol and charcoal-hemoperfusions during Forty-one days.
abstract: The clinical course of a 26 year old female patient with acute liver necrosis and coma due to hepatitis B is reported. The disturbances of conciousness had improved. The patient survived 41 days after the beginning of the coma and developed liver cell regeneration and an acute post-hepatitic liver cirrhosis. As a grave complication a septicemia with aspergillus was observed. The patient died because of gastro-intestinal hemorrhage. At autopsy there were no signs of brain edema. The treatment consisted in: daily infusions with coenzyme A, nicotinamid-adenin-dinucleotide, alpha lipoic acid and cocarboxylase to improve the metabolic disorders and the clinical picture; mannitol intravenously to prevent and to treat cerebral edema; 33 charcoal-hemoperfusions to remove toxic substances of acute liver failure. Treatment of the aspergillus infection with 5-fluorocytosine and amphotericine B and infusion of concentrated ascites led to a decompensation of liver functions. From this observation the following conclusions can be drawn: after an acute viral hepatic necrosis, new synthetic functions and improvements of the disturbed intermediary metabolism in regenerated liver-cells can eventually be seen only after twenty-four to thirty days. With systematically applicated mannitol infusions it is possible to treat cerebral edema effectively.
mesh_terms: D000328:Adult; D001929:Brain Edema / Q000473:pathology / Q000628:therapy; D002606:Charcoal / Q000627:therapeutic use*; D003067:Coenzymes / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006501:Hepatic Encephalopathy / Q000473:pathology / Q000628:therapy; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D007263:Infusions, Parenteral; D008103:Liver Cirrhosis / Q000473:pathology / Q000628:therapy*; D008353:Mannitol / Q000008:administration & dosage*; D013997:Time Factors
chemical_list: D003067:Coenzymes; D002606:Charcoal; D008353:Mannitol