A 57 year old man with chronic renal failure and cardiac tamponade who developed ischemic hepatitis.
Ischemic hepatitis is an infrequent entity, usually associated with low cardiac out put. We present a case of a 57 year-old man with chronic renal failure and cardiac tamponade who developed elevation of serum alanine transferase level of 5,054 U/L, aspartate transferase level of 8,747 U/L and lactate dehydrogenasa level of 15,220 U/L. The patient developed hepatic encephalopathy and hypoglycemia. Liver Doppler ultrasound was normal. He was seronegative for HBV and HCV, drugs list was scrutinized for the names of known hepatotoxins. Ischemic hepatitis was diagnosed. The hypoglycemia and encephalopathy were solved and the patient was discharged with normal transaminase levels. Ischemic hepatitis is typically preceded by hypotension, hypoxemia, or both. As one would expect, the most common cause of sustained systemic hypotension is cardiovascular disease. Liver biopsy is usually not necessary. The best treatment is support measures and correct the underlying condition.
Liver Unit, Medica Sur Clinic & Foundation, Mexico. ericlopezmendez@yahoo.com.mx
Eric
E
López-Méndez
Eduardo
E
López-Méndez
Iván
I
López-Méndez
Pablo
P
Hernández-Reyes
Jaime
J
Galindo-Uribe
Vanessa
V
Angulo-Ramírez
Lourdes
L
Avila-Escobedo
Misael
M
Uribe
D002305:Cardiac Tamponade / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003131:Combined Modality Therapy; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005500:Follow-Up Studies; D006505:Hepatitis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007511:Ischemia / Q000150:complications* / Q000175:diagnosis; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008099:Liver / Q000098:blood supply*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D016896:Treatment Outcome