Optimal management of patients with fulminant hepatic failure: Targeting the brain

Cerebral Glutamine Concentration and Lactate–Pyruvate Ratio in Patients with Acute Liver Failure

“…Furthermore, there is accumulating evidence that development of brain edema in ALF patients, with several failing organ systems, is multi-factorial. Other aspects such as systemic inflammatory response, sepsis, inappropriate fluid therapy causing hypo-tonicity, and impaired cerebral blood flow autoregulation could also be of importance [7,20,27,28]. However, assessment of all these confounding factors requires much larger datasets compared to this small clinical study.…”

“…As shown in this study, such a favorable milieu is not present in the brain in ALF. The consequence is failure of ''regulatory volume decrease'' of astrocytes [20]. Thus, this integrated view implies that the osmotic stress caused by accumulation of glutamine in the astrocytes is only the ''first hit'' to the brain.…”

Comparison of terlipressin and noradrenalin on cerebral perfusion, intracranial pressure and cerebral extracellular concentrations of lactate and pyruvate in patients with acute liver failure in need of inotropic support

“…This finding has potentially important implications if this effect is more profound than that seen with the use of other pressors [4]. After all it is well described that also NA increases both CBF [7][8][9] and ICP in some patients [9].…”

“…administration of fluids and pressors [4,5]. Such therapy increases cardiac output and arterial pressure to a level that ensures sufficient perfusion of vital organs such as the brain [5].…”

Point-of-care continuous13C-methacetin breath test improves decision making in acute liver disease: Results of a pilot clinical trial

“…Current predictors of survival in patients with FHF are far from optimal [12,13] . Thus, it is often problematic to make decisions concerning medical treatment and time of transplantation based on clinical and laboratory assessments [14][15][16] . A therapeutic dilemma arises from the need to provide expedient transplants to patients with a failing liver while avoiding unnecessary transplantations in patients that are likely to recover spontaneously [17][18][19] .…”