[HSF] Hepatic protective strategies

[prasannasimha]

Yes the patient was having persistent hyperbilirubinemia. We withdrew 
all drugs with potential hepatotoxicity. He had surprisingly no major 
increase in SGOT/PT and no evidence of prehepatic or post hepatic causes 
but his bilrubin proceeded to rise. He finally died of hepatic 
encephalopathy and Hepato-renal syndrome.
He had received GIK preoperatively peri and post operatively. One thing 
ws post operatively with onset of hepatic dysfunction we had a tough 
time managing glucose levels - persistent hypoglycemia so after some 
time we were running virtually Glucose - Pottasium with no Insulin as we 
could just not manage even with increased parenteral and eenteral 
feeding. There was no evidence of overt sepsis though one blood culture 
came positive much later and we had treated him.He was afebrile 
throughout with minimally raised / normal counts .
He was one of those cachectic patients with severe MR TR and pulsatile 
liver down upto the umbilicus.
Prasanna

Nasser F. Abou'Seada wrote:
> Prasanna: 
> do you have the details ?
> Gik goes pre-, intra, and post op
> best is pre ...
> did the patient die inspite hepatic support ?
> what parameters ?
>
> NFA
>
>   
>> -----Original Message-----
>> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-
>> bounces at lists.hsforum.com] On Behalf Of prasannasimha
>> Sent: Tuesday, January 02, 2007 11:46 AM
>> To: OpenHeart-L at lists.hsforum.com; ccm
>> Subject: [HSF] Hepatic protective strategies
>>
>> Can the members enumerate their strategies to protect the Liver during
>> CPB.  I am having a spate of patients with severe TR (concomitant mitral
>> valve disease)and congestive hepatopathy. One patient died
>> postoperatively of fulminant hepatic failure in the presence of good
>> hemodynamics. I am following feeding etcd preoperatively and Nasser's
>> protocol preop.
>> Prasanna
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