Successful Management of Stage IV Hepatic Coma in a Child by Haemocarboperfusion
Hepatic failure and its encephalopathy (grade IV coma) carries a mortality rate of 60 to 70% in children under 15 years of age (Silverman et al., 1971). Current treatment is predominantly aimed at curtailing known precipitants with anti-ammonia regimens, potassium repletion (Conn, 1973), amine replacement (Colon and Sandberg, 1973), and other supportive care. Recent attention has turned towards methods for removing accumulated toxic metabolites. Exchange transfusion, human, primate and pig cross-circulation, and dialysis have all been used with limited success. Recently, carboperfusion has been successfully employed to reverse the encephalopathy of hepatic failure (Gazzard et al., 1974; Gelfand et al., 1976). In this report we describe the successful treatment of grade IV hepatic encephalopathy in a 13-year-old boy. This patient represents the youngest reported case treated successfully with haemoperfusion.
Unable to display preview. Download preview PDF.
- Colon, A. K. and Sandberg, D. H. (1973). Hepatic encephalopathy treated with L-Dopa. Pediatrics, 51, 1105–1106.Google Scholar
- Conn, H. O. (1973). Current diagnosis and treatment of hepatic coma. Hosp. Prac., 8, 65–72.Google Scholar
- Gazzard, B. G., Weston, M. J., Murray-Lyon, I. M., Flax, H., Record, C. O., Portman, B., Langley, P. G., Dunlop, E. H., Mellon, P. J., Ward, M. B. and Williams, R. (1974). Charcoal haemoperfusion in the treatment of fulminant hepatic failure. Lancet, 1, 1301–1306.Google Scholar
- Gelfand, M. C., Knepshield, J. H., Cohan, S., Ramirez, B. and Schreiner, G. E. (1976). Treatment of hepatic coma with haemoperfusion through polyacrylamide hydrogel-coated charcoal. Kidney International (in press).Google Scholar
- Silverman, A., Roy, C. C. and Cozzetto, F. J. (1971). Pediatric Clinical Gastroenterology Mosby, St. Louis, pp. 366–367.Google Scholar