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.
López-Méndez
Eric
E
Liver Unit, Medica Sur Clinic & Foundation, Mexico. ericlopezmendez@yahoo.com.mx
López-Méndez
Eduardo
E
López-Méndez
Iván
I
Hernández-Reyes
Pablo
P
Galindo-Uribe
Jaime
J
Angulo-Ramírez
Vanessa
V
Avila-Escobedo
Lourdes
L
Uribe
Misael
M
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