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Background: Yellow phosphorus containing rodenticide poisoning are common in Adult critical care. They cause coagulopathy and liver cell failure in humans. Till date, only liver transplants had been advocated as the final treatment of fulminant liver failure occurring as a complication of rodenticide poisoning. In this study, an innovative Treatment approach was given to liver cell failure cases who had consumed yellow phosphorus paste.Methods: Retrospective analysis of case records of liver cell failure cases due to the consumption of phosphorus containing Rodenticide poisonings, were analysed for a period of 1 year from January 2018 to January 2019 in a public hospital. Medical case records were obtained from records department and Postmortem registers. Symptoms, signs, investigations, treatments, complications, and outcomes were tabulated.Results: Total 11 cases were studied. 8 cases of liver cell failure and coagulopathy in whom therapeutic heparin free plasmapheresis was given, recovered completely from liver cell failure. A significant drop in Haemoglobin, platelet count, PT INR Ratio and rise in serum alkaline phosphatase, were the predictable factors used for the intervention of therapy with 5 cycles of heparin free plasmapheresis to eliminate toxic effects of phosphorus on liver cells and in the blood. A comparative analysis of untreated cases (n=3) vs treated with plasmapheresis (n=8), showed a significant statistical difference (P <0.005) in outcomes with a degree of freedom=2.Conclusions: Plasmapheresis can be a therapeutic treatment for liver cell failure caused due to the consumption of yellow phosphorus. Predictable factors for impending liver cell failure in whom plasmapheresis will be of benefit are dependent upon prothrombin time, INR ratio, Liver enzymes and time interval between consumption and onset of liver cell failure.
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@#<p style="text-align: justify;"><b>OBJECTIVE:</b> To evaluate the efficacy of L-ornithine-L-aspartate (LOLA) in improving minimal hepatic encephalopathy in adult patients with liver cirrhosis.</p><p style="text-align: justify;"><b>METHODS:</b> A search in PubMed, Cochrane Library, Google Scholar, and Medline was made obtaining four qualified randomized controlled trials. Studies included adult cirrhotic patients with minimal hepatic encephalopathy measured by the number connection test (NCT-A, B), figure connection test (FCT-A, B), picture completion, block design test, and critical flicker frequency (CFF) testing with a cut-off score of</p><p style="text-align: justify;"><strong>RESULTS:</strong> Of the 29 studies identified, 4 fulfilled the inclusion criteria, which entailed analysis of 238 participants (LOLA: 116, Control: 122). Three out of the four studies were used in meta-analysis and one study was analyzed separately due to a difference in the neuropsychometric measure. The meta-analysis favored the experimental group (LOLA), with a mean difference of 2.29 (95% CI 0.72 - 3.86), p-value = 0.004, and an I2 of 18%.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> LOLA provided great potential in managing encephalopathy since treating earlier related to better survival and prevention of disease progression. The results of our study supported such evidence and its use may be encouraged.</p>
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Humans , Fibrosis , Hepatic EncephalopathyABSTRACT
OBJECTIVE:To explore the protective effect of L-ornithine-L-aspartate on ischemia-reperfusion injury after partial hepatectomy. METHODS:104 patients underwent partial hepatectomy(vessel occlusion in portal fissure)were randomly divided in-to control group(53 cases)and trial group(51 cases). Control group was given routine liver-protective drugs,and trial group was additionally given L-ornithine-L-aspartate 10 g added into 5%Glucose injection 250 ml intravenously before surgery,for 7 consecu-tive days. The fasting peripheral venous blood was collected in 2 groups on first day before surgery and first,forth and sixth day af-ter surgery to detect liver function;the changes of main aminopherase index(ALT and AST)were compared between 2 groups at different portal fissure vessel occlusion time after surgery. RESULTS:There was no statistical significance in the difference of liver resection range,blood loss,first porta hepatis vessel occlusion time and anesthesia time in both groups during operation (P>0.05). Compared to before surgery,liver function indexes raised to different extent in 2 groups after surgery,with statistical signifi-cance(P0.05). Among those patients under-went porta hepatis vessel occlusion with Pringle method and with occlude occlusion time ≥15 min,the AST and ALT level of con-trol group was higher than those of trial group after surgery,but albumin level was below trial group,with statistical significance (P<0.05). CONCLUSIONS:L-ornithine-L-aspartate could improve liver function fast and effectively for partial hepatectomy pa-tients,especially for the patients underwent porta hepatic vessel occlusion with Pringle method for a long time(obvious ischemia-re-perfusion injury).
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Objective To study the efficacy and side effects of Ganciclovir combined with L-ornithine-L-aspartate on infant cytomegalovirus(CMV) hepatitis.Methods Sixty infants with CMV hepatitis hospitalized in our hospital from Dec.2009 to Dec.2010 were treated with ganciclovir combined with L-ornithine-L- aspartate.The parameters observed in the study included the pre-and post-treatment data on total Bilirubin (TBIL),alanine aminotransferase (ALT),alkaline Phosphatase (AKP)and the retraction of liver and spleen,as well as the adverse reactions of the treatment.Results The treatment significantly decreased serum TBIL (t =5.74,P ＜ 0.05 ),ALT( t =2.92,P ＜ 0.05 ) and liver( t =8.27 P ＜ 0.05 ) and spleen volume ( t =5.03,P ＜0.05).However,side effects such as liver damage and rash occurred occasionally during the ganciclovir treatment.Intravenous infusion of L-omithine-L-aspartate caused side effects such as vomiting and other mild gastrointestinal reactions.Conclusion The treatment of Ganciclovir combined with L-ornithine-L-aspartate on infant cytomegalovirus hepatitis created good efficacy and can be considered as the first treatment choice.Though it is relatively safe,adverse reactions should be monitored during the treatment.
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Objetivo: determinar la efectividad de la terapia combinada lactulosa/l-ornitina l-aspartato (L/LOLA) vs lactulosa (L) en relación a la mejoría clínica de acuerdo a la escala West Haven y reducción de amonio en los pacientes con encefalopatía hepática durante 7 días. Metodología: estudio retrospectivo de expedientes clínicos de los pacientes ingresados desde enero 2006 a diciembre 2010 con diagnóstico de encefalopatía hepática en el hospital Luis Vernaza. Resultados: se revisaron 301 registros médicos de los cuales 78 fueron elegidos para el estudio (L=31, L/LOLA=47) evidenciándose predominio en grados de encefalopatía II con 38.5% (n=30) y III con 51.3% (n=40) de la población total estudiada. Se observó que el 80.65% (n=25) de los pacientes con lactulosa mejoraron su estadío de encefalopatía vs el 65.96% (n=31) del grupo con terapia combinada (p=0.16). En relación al amonio se encontró una disminución de 84.19mcg/dL en el grupo con lactulosa vs 80.83 mcg/dL con la terapia combinada (p=0.45). Se encontró que el 66.6% (n=52) del total de pacientes en estudio tuvieron MELD (Model for End-Stage Liver Disease) > 16. Finalmente el 78.2% (n=61) de la población del estudio cursó con trombocitopenia. Conclusiones: la terapia combinada no demostró resultados significativos comparados con lactulosa al evaluar mejoría clínica y reducción de niveles de amonio a los 7 días. Se debe realizar estudios prospectivos usando LOLA con mayor duración de terapia y evaluar terapias complementarias.
Objective: to determine the effectiveness of the lactulose/l-ornithine l-aspartate (L/LOLA) combined therapy vs. lactulose (L) in relation to clinical improvement according to the West Haven scale and the reduction of ammonia in patients with hepatic encephalopathy during 7 days. Methodology: retrospective study of the medical records of patients admitted to the Luis Vernaza hospital with a diagnosis of hepatic encephalopathy from January 2006 to December 2010. Results: 301 medical records were reviewed of which 78 were chosen for the study (L=31, L/LOLA=47) showing a prevalence of grade-II encephalopathy of 38.5% (n=30), and grade-III encephalopathy of 51.3% (n=40) of the total study population. It was observed that 80.65% (n=25) of the patients with lactulose improved their stage of encephalopathy vs. 65.96% (n=31) of the combined-therapy group (p=0.16). With respect to the ammonium, there was a decrease of 84.19 mcg/dL in the lactulose group vs. 80.83 mcg/dL in the combined therapy group (p=0.45). We found that 66.6% (n=52) of all the study patients had MELD (Model for End-Stage Liver Disease) > 16. Finally, 78.2% (n=61) of the study patients showed thrombocytopenia. Conclusions: the combined therapy did not show significant results compared with only lactulose when assessing clinical improvement and the reduction of ammonia levels after 7 days. Prospective studies should be done using LOLA with a longer duration of therapy; complementary therapies should also be evaluated.
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Male , Adult , Female , Middle Aged , Hepatic Encephalopathy/therapy , Lactulose/therapeutic use , Ornithine , Hyperammonemia , Liver CirrhosisABSTRACT
Objective To evaluate the influence of L-ornithine-L-aspartate (LOLA) on model for end stage liver disease(MELD) score and liver function of patients with chronic liver failure (CLF). Methods Sixty patients consecutively admitted to our hospital from May, 2002 and November, 2008 were enrolled into the study and randomly divided into low dose group (LD group, LOLA:10 g/d) and high dose group (HD group, LOLA :20 g/d)After treatment of LOLA, the clinical data ( serum NH3 , MELD score and liver function ) were compared between the two groups. Results Compared to serum NH3 level before treatment, serum NH3 decreased ( 62.59 + 27.87 )μmoL/L in the HD group and (49.36 + 27.34 ) μmol/L in the LD group, and both decreasements were statistical significant (Ps ＜ 0. 05 ). Compared to MELD before treatment, MELD score decreased ( 8.38 ± 2. 24 ) and ( 14.57 + 7.68), respectively ( Ps ＜ 0.05 ). Compared to LD group, all indices of liver function in the HD group improved more compared to those of the LD group ( Ps ＜ 0.05 ). Conclusions LOLA could significantly decrease serum NH3 and MELD score and improve liver function in CLF patients.
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Objective To study efficacy of L-ornithine-L-aspartate (Hepa-Merz) in treatment for nonalcoholic steatohepatitis (NASH) and its effect on lowering serum level of triglycerine MethodsTotally, 30 patients with nonalcoholic steatohepatitis diagnosed by liver function test, B ultrasound scanning and liver biopsy were treated by intravenous infusion of L ornithine L aspartate (Hepa Merz) 10 g daily for 21 days Activities of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and serum level of triglycerine (TG) were determined for all the cases before and after treatment Results Activities of serum ALT and AST and serum level of TG were restored to normal in 29 (96 7%) and in 28 (93 3%) of 30 patients, respectively, after treatment No serious adverse effects were found during treatment Conclusions L ornithine L aspartate (Hepa Merz) is a safe and effective drug in treatment for nonalcoholic steatohepatitis, and can lower serum level of triglycerine significantly