Acute Infectious Hepatitis with Fulminant Hepatic Failure – A Study of 289 Cases
Deshpande, R.S., M.B., B.S., D.P.H. Medical Superintendent In-charge, Kasturba Hospital for Infectious Diseases, Sane Guruji Marg, Bombay, India
Maximum age incidence was between the ages of 11 years and 40 years. i.e. a total of 249 cases (86.20% approximately) out of 289 cases. A total of 165 cases (57%) out of 289 were between 21 - 30 years of age.
Fifty patients were admitted in a gasping condition. In spite of treatment 52 died within 48 hours of admission and another 57 died on 3rd and 4th days. Thus 109 patients expired within 96 hours of admission. Liv.52 therapy being oral is expected to take at least 48 hours before clinical effects can be observed. Therefore, in compiling the results, the cases who died within 48 hours of admission, i.e. before the oral drug could act, have been excluded. The duration of stay in hospital in 126 patients who survived was 1 to 10 days in 19 cases, 10-20 days in 63 cases, 21-30 in 28 cases, 31-40 in 12 cases, and 41 to 50 in 4 cases.
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Table VI: Symptoms on admission |
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Jaundice |
289 |
High coloured urine |
289 |
Nausea |
76 |
Vomiting |
48 |
Pain in abdomen |
82 |
Fever |
41 |
Semi-consciousness |
14 |
Comatose |
47 |
Oedema |
2 |
Gasping on admission |
50 |
During the course of study blood pressure readings were below normal levels in most of the semicomatose, comatose and toxic patients.
RESULTS OF THERAPY
Laboratory findings showed bile salts and pigments were present in the urine in all the cases. Initially blood bilirubin showed between 21-30 mg% in comatose patients and 15-20mg% in a large number of precomatose patients. In other cases it ranged between 4-15 mg%. In a very few cases was it below 4 mg%. On therapy, 109 patients died within 96 hours of admission. Blood bilirubin was high in most of these cases. Direct blood bilirubin levels were comparatively and proportionately lower in all the cases.
Table VII: Symptoms and signs - 289 cases |
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High coloured urine |
289 cases |
Palpable liver |
37 |
Jaundice |
289 |
Oedema |
37 |
Nausea |
105 |
Responding to painful stimuli |
46 |
Vomiting |
114 |
No response to painful stimuli |
44 |
Pain in abdomen |
130 |
Headache |
2 |
Fever |
210 |
Tachycardia |
7 |
Dull |
3 |
Haemoptysis |
1 |
Drowsy |
50 |
Haematemesis |
1 |
Semi-consciousness |
73 |
Malenae |
1 |
Unconsciousness |
117 |
Bladder distension |
2 |
Giddiness |
14 |
Difficulty in micturition |
1 |
Abnormal behaviour |
6 |
Chest signs |
20 |
Liver tenderness |
92 |
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Routine blood examination showed mild leucocytosis with slight relative polymorpho-nuclear leucocytosis. SGOT and SGPT levels were initially higher and varied from SGOT 93 to 435 units and SGPT from 150 to 675 units and gradually returned to low levels on improvement. Liver biopsy studies could not be carried out as many patients were critically ill and the procedure would be hazardous due to the toxic condition of the patient and the tendency to bleeding. After therapy total blood bilirubin was below 2 mg in a large number of cases that recovered. Blood bilirubin studies were not possible in all cases. Gradual reduction in levels was found in cases, which improved.
Out of a total of 289 cases of acute infectious hepatitis with fulminant hepatic failures, 163 patients (56.4%) expired, 126 were cured and discharged from within 10 days to 50 days (Table VIII).
However, out of the 163 patients who expired, 52 were moribund on admission or expired within the first 48 hours before the oral therapy could act. If these patients are excluded, then from a total of 237 very serious cases admitted at the City Fever Hospital, a large number of whom were in a state of precoma or coma with toxaemia, 126 were cured, giving 53.16% survival rate (Table IX). At no stage did we encounter any sort of toxic or side effects with Liv.52.
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SUMMARY AND CONCLUSIONS
1. Acute Fulminant Hepatic failure presented clinically as cases of infectious hepatitis with precoma and coma has been studied.
2. Etiopathology clinical features and results of various present-day modes of therapy are reviewed and discussed.
3. 289 cases of acute infectious hepatitis with fulminant hepatic failure are observed and studied for the effects of Liv.52 therapy in addition to the usual conventional modes of therapy at this institution.
4. Age and sex incidence, seasonal incidence and clinical features and results of laboratory findings in these cases are presented.
5. Results show the cure rate of 53% i.e. 126 patients out of 237 patients (excluding 52 moribund patients admitted in a gasping condition and who died within 48 hours of admission before the oral therapy could become therapeutically effective).
6. There were no acute or subacute toxic effects of the drug observed in this study.
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Refference: http://www.himalayahealthcare.com/pdf_files/liv224.pdf
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