[Acute liver failure after therapeutic hyperthermia].
METHODS
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Hammerschmidt
S
S
Medizinische Klinik, Universität Würzburg.
Wahn
H
H
Langmann
P
P
Scheppach
W
W
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001803:Blood Transfusion; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007792:Lactulose / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008875:Middle Aged; D009355:Neomycin / Q000627:therapeutic use; D009369:Neoplasms / Q000628:therapy; D010289:Parenteral Nutrition, Total; D013997:Time Factors
D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D007792:Lactulose; D009355:Neomycin
Akutes Leberversagen nach Hyperthermiebehandlung.