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Liver disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
There is a markedly increased mortality rate in pregnant women, particularly if the virus is acquired in the third trimester. There is an increased incidence of hepatic encephalopathy and fulminant hepatic failure.
Toxicology
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
The patient is usually asymptomatic, but can present in fulminant hepatic failure with abdominal pain, vomiting, jaundice, tender hepatomegaly and encephalopathy. Coagulopathy, hypoglycaemia and metabolic acidosis occur in severe poisoning.
Short-chain 3-hydroxyacylCoA dehydrogenase (SCHAD) deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Sudden infant death has also been reported [9, 10]. One such infant had brick red urine, indicative of myoglobinuria. Autopsy revealed a fatty liver. Fulminant hepatic failure has also been observed, treated by liver transplantation [10].
Toxicity of chloroquine and hydroxychloroquine following therapeutic use or overdose
Published in Clinical Toxicology, 2021
Cassandra Doyno, Diana M. Sobieraj, William L. Baker
The most common toxicities occurring in the first weeks of chloroquine or hydroxychloroquine therapy are gastrointestinal. During weeks 0–6 at doses of 800–1200 mg/day, nausea, vomiting, and abdominal pain occurred in 20–50% of individuals with rheumatoid arthritis [19]. Self-reported incidence of anorexia, diarrhea, nausea, and vomiting was 6–10% amongst tourist and business travelers using chloroquine for malarial prophylaxis [20]. Evaluations of more recent pharmacovigilance databases reveal similar incidences [21]. The risk of gastrointestinal adverse effects was significantly lower with other malarial prophylaxis agents (e.g., atovaquone, mefloquine) compared with the combination of chloroquine-proguanil (relative risk 0.71, 95% confidence interval 0.60–0.85) [13]. Fulminant hepatic failure was reported in two cases, developing within the first two weeks of initiation of treatment [22].
Hepatitis E should be a global public health priority: recommendations for improving surveillance and prevention
Published in Expert Review of Vaccines, 2020
Carl D Kirkwood, Katherine R Dobscha, A Duncan Steele
There is no specific treatment for hepatitis E. Patients with the uncomplicated infection do not require definitive treatment, with mild cases typically managed through rest and dietary modification. When acute hepatitis leads to fulminant hepatic failure, patients require supportive intensive care and early transplant if available, but the median time between the onset of ALF and death, transplant, or recovery is less than a week [64]. The use of antivirals (ribavirin and alpha-interferon) has been limited to treating chronic HEV3 infections in transplant patients. Recent studies have found some potential drug candidates with antiviral activity against HEV1 in vitro [64,65], however, there is insufficient evidence to support antiviral use for HEV-induced acute hepatitis. Antiviral therapy can be challenging in resource-poor settings due to a lack of generic options and or access to care [66]. Both interferon and ribavirin are also contraindicated during pregnancy, limiting their potential utility for the highest-need populations [64].
Therapeutic targets for liver regeneration after acute severe injury: a preclinical overview
Published in Expert Opinion on Therapeutic Targets, 2020
Hidenobu Kojima, Kojiro Nakamura, Jerzy W. Kupiec-Weglinski
Plasma exchange and albumin dialysis have been clinically used in ALF. Albumin dialysis improved encephalopathy, however, no significant survival benefit has been reported for a randomized, prospective cohort with either form of albumin dialysis [94]. While plasma exchange or albumin dialysis support liver regeneration with alleviation of acute liver injury, bioartificial liver (BAL) containing liver cells aim to substitute for liver function. In a prospective, randomized controlled study of BAL using porcine hepatocytes, the survival benefit was not significant in 171 patients with fulminant/sub-fulminant hepatic failure and primary nonfunction after liver transplantation [95]. In a recent prospective, randomized controlled study in 203 patients, no significant difference in survival was recorded between BAL using hepatoblastoma-derived cells vs. controls [96]. There are no published data documenting the clinical efficacy of BAL.