Martínez CHA, González RBJR

Language: Spanish
References: 32
Page: 334-342
PDF size: 185.52 Kb.

ABSTRACT

The current concept is the presence of coagulopathy (TP ›15seg or INR ›1.5) and hepatic encephalopathy within the first 8 weeks of symptoms without previous hepatic disease. And subacute hepatic failure begins into the 8 and 26 weeks after the begin of symptoms. The main explain is the viral hepatitis (72% cases) and the pharmacologic toxicity. Of the patients whit viral hepatitis only 1% present AFHF explained about the host idiosyncratic and the viral load. The B hepatitis virus present 1% of AFHF and is the most common (70%) cause. The E hepatitis virus infection had a high incidence of AFHF and had the 40% of mortality in pregnant women. In the solvent and glue addicts, and the industrial workers with hydrocarbons expose common develop AFHF. A predictable cause is the acetaminophen that consume the storage of gluthathion increasing the acetaminophen toxicity. Other drugs have reported the development of AFHF like halotane, sulfonamides and phenitoin, considered idiosyncratic causes. The pregnancy fatty liver occurs in the third trimester of pregnancy it is characterized by acute encephalopathy and jaundice. The AST level reaches the 1000U/L, but the best severity marker is the prothrombin time and the mental status. Other cause is the HELLP syndrome characterized by high levels of AST, hemolysis, thrombocitopeny and preeclampsy, with a fetal mortality of 40%. Previously healthy patients start with attack or nauseas, followed by acute jaundice and an altered mental status, these patients can forward of a healthy state to the death in 2 to 10 days lapse. The corner stones are the altered metal status and the prolonged prothrombin time. The primary therapy assays have been unhopeful and the heroic measures in the desperate situations had poor value. Recently a study of 17 tertiary care centers reported a survive rate of 67% to 3 weeks. Reporting a survive rate of 68% for transplanted patients secondary to acetaminophen toxicity, 25% for idiosyncratic reactions and 17% for indeterminate causes. The transplant therapy can improve the patients survival rate, but not all the patients can reach this option. The main objective is to improve the mental status and some biochemistry parameters. In conclusion the AFHF is a severe situation in patients previously healthy with a high mortality index, and the approach must be interdisciplinary for determine the need of transplant and opportune intervention.

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