[HSF] Hepatic protective strategies

[Salerno, Tomas]

this has happened to me once and i never found the cause.
 
Tomas

________________________________

From: openheart-l-bounces at lists.hsforum.com on behalf of prasannasimha
Sent: Tue 1/2/2007 9:24 PM
To: OpenHeart-L at lists.hsforum.com
Subject: Re: [HSF] Hepatic protective strategies



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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