Failure of insulin and glucagon infusion to stimulate liver regeneration in fulminant hepatic failure.
A randomised controlled trial of insulin and glucagon infusion was carried out in 18 patients in grade III or IV coma from fulminant hepatic failure due to viral or drug-induced hepatic necrosis to see whether mortality could be reduced by stimulating hepatic regeneration. Nine patients received a continuous infusion of insulin 3 U/h and glucagon 200 micrograms/h made up in 5% dextrose containing 1% human albumin solution (HAS) while controls received 5% dextrose and HAS alone. Baseline plasma insulin and glucagon levels were comparably raised in both groups and, on infusion, rose significantly higher in the insulin- and glucagon-treated patients compared to controls. Two control and one treated patient recovered. Median survival time from enrolment to death was similar for insulin- and glucagon-treated patients and controls--2 and 3 days, respectively. Insulin and glucagon therapy did not enhance hepatic synthetic function, as measured by a fall in prothrombin time or a rise in alpha-fetoprotein; nor did it stimulate hepatic regeneration, only one patient in each group showed histological evidence of hepatic regeneration at post-mortem.
Harrison
P M
PM
Liver Unit, King's College Hospital, School of Medicine and Dentistry, Denmark Hill, London, United Kingdom.
Hughes
R D
RD
Forbes
A
A
Portmann
B
B
Alexander
G J
GJ
Williams
R
R
D000328:Adult; D000368:Aged; D005260:Female; D005934:Glucagon / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology*; D008107:Liver Diseases / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D008115:Liver Regeneration / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic
D007328:Insulin; D005934:Glucagon