Sa1481 NAC ATTACK UPDATE: AN EMERGING THERAPY FOR ISCHEMIC HEPATOPATHY

Kothari, Shana; Kalinowski, Michael; Kobeszko, Matthew; Brindise, Elizabeth; Silva, Rogelio G.

doi:10.1016/s0016-5085(20)33926-3

Cited by 1 publication

(2 citation statements)

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“…Ischaemic hepatitis is present in 1-2.5% of ICU admissions and is associated with a high in-hospital mortality between 25-50%. 2,4,5 Decreased perfusion of approximately 15-20 minutes is sufficient to cause hepatocyte necrosis. 6,7 In our case report, there was intermittent portal clamping for a total of 90 minutes due to difficulty gaining haemostasis from the iatrogenic IVC injury.…”

Section: Discussionmentioning

confidence: 99%

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N-acetylcysteine therapy for ischaemic hepatic failure: a successful antidote

2021

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Acute liver failure (ALF) is characterised by severe liver injury with the onset of coagulopathy (INR ≥1.5) and encephalopathy in the absence of pre-existing liver disease. It is associated with a high mortality rate of 10-57%, which is largely driven by multi-organ failure, sepsis and cardiac arrhythmia. Current management focuses on identifying and treating the aetiology, providing supportive care and monitoring liver function. The use of N-acetylcysteine (NAC) therapy is well-studied in the treatment of paracetamol toxicity but is controversial in other causes of ALF. We reported the first case of ischaemic hepatic failure secondary to prolonged portal vein occlusion treated with 72 hours of NAC therapy. Although ischaemic hepatopathy is a relatively uncommon cause of ALF, it is associated with a high mortality rate. The case highlights how early use of NAC therapy may improve hepatic serology biomarkers and should warrant consideration in ALF secondary to ischaemic hepatopathy.

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Section: Discussionmentioning

confidence: 99%

“…The use of NAC therapy is wellestablished in paracetamol-induced ALF, however its effects of improved regional blood flow, anti-apoptotic and antioxidant defences may be beneficial in other forms of ALF. 3,4 We reported a case of ischaemic hepatopathy secondary to prolonged vascular occlusion that resolved after NAC therapy.…”

Section: Introductionmentioning

confidence: 99%