title: Indomethacin for treatment of refractory intracranial hypertension secondary to acute liver failure.
abstract: OBJECTIVE
  Successful use of i.v. indomethacin for urgent management of elevated intracranial pressure (ICP) due to acute liver failure is reported.
  
  
  CONCLUSIONS
  A 42-year-old woman receiving intensive care for fulminant hepatic failure secondary to acetaminophen toxicity developed cerebral edema and intracranial hypertension refractory to standard pharmacotherapy and respiratory support measures. A computed tomography (CT) scan of the patient's head was ordered as part of an evaluation for liver transplantation, but the patient's severely elevated ICP precluded supine positioning for the CT study (throughout the hospital stay, the head of the patient's bed was kept at a 30° angle to optimize cerebral venous outflow). With administration of indomethacin 10 mg by i.v. injection, the ICP decreased from 29 to 13 mm Hg and remained at goal after the patient was placed in a fully supine position for a period long enough to permit the CT scan. Indomethacin was used a second time to facilitate CT imaging several days later. No adverse effects attributable to indomethacin use were documented. Although the patient underwent successful liver transplantation, her mental status and overall clinical status continued to deteriorate and she died on postoperative day 12.
  
  
  CONCLUSIONS
  Despite the poor overall patient outcome in this case, i.v. indomethacin was successfully used to decrease ICP in order to facilitate CT imaging as part of a transplantation eligibility workup.
authors.affiliation: Mathew C. Jones, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Neurointensive Care, Department of Pharmacy, Henry Ford Hospital, Detroit, MI. Tracey Lasak-Myall, Pharm.D., BCPS, ATC, is Associate Medical Scientific Liaison, Allergan, Inc., Irvine, CA. Tamer M. Abdelhak, M.D., is Director of Neurocritical Care, Southern Illinois University School of Medicine, Springfield. Panayiotis N. Varelas, M.D., Ph.D., is Director, Neurosciences Intensive Care Unit, Henry Ford Hospital. At the time of writing, Drs. Lasak-Myall, Abdelhak, and Varelas worked at Henry Ford Hospital. mjones18@hfhs.org.
authors.forename: Mathew C
authors.initials: MC
authors.lastname: Jones
authors.affiliation: Mathew C. Jones, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Neurointensive Care, Department of Pharmacy, Henry Ford Hospital, Detroit, MI. Tracey Lasak-Myall, Pharm.D., BCPS, ATC, is Associate Medical Scientific Liaison, Allergan, Inc., Irvine, CA. Tamer M. Abdelhak, M.D., is Director of Neurocritical Care, Southern Illinois University School of Medicine, Springfield. Panayiotis N. Varelas, M.D., Ph.D., is Director, Neurosciences Intensive Care Unit, Henry Ford Hospital. At the time of writing, Drs. Lasak-Myall, Abdelhak, and Varelas worked at Henry Ford Hospital.
authors.forename: Tracey
authors.initials: T
authors.lastname: Lasak-Myall
authors.affiliation: Mathew C. Jones, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Neurointensive Care, Department of Pharmacy, Henry Ford Hospital, Detroit, MI. Tracey Lasak-Myall, Pharm.D., BCPS, ATC, is Associate Medical Scientific Liaison, Allergan, Inc., Irvine, CA. Tamer M. Abdelhak, M.D., is Director of Neurocritical Care, Southern Illinois University School of Medicine, Springfield. Panayiotis N. Varelas, M.D., Ph.D., is Director, Neurosciences Intensive Care Unit, Henry Ford Hospital. At the time of writing, Drs. Lasak-Myall, Abdelhak, and Varelas worked at Henry Ford Hospital.
authors.forename: Tamer M
authors.initials: TM
authors.lastname: Abdelhak
authors.affiliation: Mathew C. Jones, Pharm.D., BCPS, is Clinical Pharmacy Specialist, Neurointensive Care, Department of Pharmacy, Henry Ford Hospital, Detroit, MI. Tracey Lasak-Myall, Pharm.D., BCPS, ATC, is Associate Medical Scientific Liaison, Allergan, Inc., Irvine, CA. Tamer M. Abdelhak, M.D., is Director of Neurocritical Care, Southern Illinois University School of Medicine, Springfield. Panayiotis N. Varelas, M.D., Ph.D., is Director, Neurosciences Intensive Care Unit, Henry Ford Hospital. At the time of writing, Drs. Lasak-Myall, Abdelhak, and Varelas worked at Henry Ford Hospital.
authors.forename: Panayiotis N
authors.initials: PN
authors.lastname: Varelas
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D019586:Intracranial Hypertension / Q000188:drug therapy* / Q000209:etiology; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000150:complications*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen; D007213:Indomethacin