title: Successful treatment of refractory cerebral oedema in ecstasy/cocaine-induced fulminant hepatic failure using a new high-efficacy liver detoxification device (FPSA-Prometheus).
abstract: Ecstasy-induced fulminant hepatic failure is associated with high mortality. If complicated by cerebral oedema, orthotopic liver transplantation is the only established treatment. We report a case of combined ecstasy/cocaine-induced fulminant hepatic failure presenting with severe rhabdomyolysis, myocardial infarction and multiorgan failure. Transplantation was declined by the transplant surgeons because of a history of intravenous drug abuse. As excessive hyperammonaemia (318 mumol/l) and refractory transtentorial herniation developed, treatment with a new liver detoxification device combining high-flux haemodialysis and adsorption (FPSA-Prometheus) was initiated. Within a few hours of treatment, ammonia levels normalised. Cerebral oedema was greatly reduced by day 4 and hepatic function gradually recovered. Following neurologic rehabilitation for ischaemic sequelae of herniation, the patient was discharged from hospital with only minimal deficits. In conclusion, efficient extracorporeal detoxification may be an option for reversal of hyperammonaemia and refractory cerebral oedema in ecstasy/cocaine-induced acute liver failure.
authors.affiliation: Department of Medicine IV, University of Vienna Medical School, Vienna, Austria. ludwig.kramer@akh-wien.ac.at
authors.forename: Ludwig
authors.initials: L
authors.lastname: Kramer
authors.forename: Edith
authors.initials: E
authors.lastname: Bauer
authors.forename: Peter
authors.initials: P
authors.lastname: Schenk
authors.forename: Rudolf
authors.initials: R
authors.lastname: Steininger
authors.forename: Marion
authors.initials: M
authors.lastname: Vigl
authors.forename: Reinhold
authors.initials: R
authors.lastname: Mallek
mesh_terms: D000328:Adult; D000641:Ammonia / Q000097:blood; D001929:Brain Edema / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D003042:Cocaine / Q000506:poisoning*; D004677:Encephalocele / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000628:therapy; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000097:blood / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D008111:Liver Function Tests; D019164:Liver, Artificial; D008297:Male; D009102:Multiple Organ Failure / Q000139:chemically induced; D009203:Myocardial Infarction / Q000139:chemically induced; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000506:poisoning*; D012206:Rhabdomyolysis / Q000139:chemically induced; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000641:Ammonia; D003042:Cocaine; D018817:N-Methyl-3,4-methylenedioxyamphetamine