Acute liver failure

Ms V, a 25-year-old girl from Maninagar, an associate professor in premier engineering college, a pHD student and a girl who is soon to get hitched to the man of his dreams. With loving parents, life could not get better for her.

Like most of the youngsters, she also used to have occasional outside food. Unfortunately, she developed vomiting, fever, muscle pain and she consulted her primary doctor. On investigations she was found to have hepatitis A virus.

Hepatitis A is the most common form of acute viral hepatitis worldwide. The virus most commonly gets transmitted by contaminated food and water. The infection is asymptomatic in 84% of children 1 and 2 years of age, 50% of children 3 and 4 years of age and 20 % of children over 5 years of age. But age increases, the severity of infection increases. The clinical illness starts with prodromal phase with symptoms of malaise, weakness, fever, anorexia and non-specific symptoms and lasts from a period of days to weeks. It is followed by an icteric phase lasting 2 to 4 weeks and is characterized by jaundice where the person turns yellow, the eyes and urine are prominently appearing yellow. In the final Convalescent phase of the disease, the virus is cleared, the patient recovers, and biomarkers become normal.A small proportion (<1%) of patients develops severe hepatitis and may develop fulminant hepatitis and acute liver failure (ALF). These patients develop multi organ failure and die in a matter of few hours to days unless transplanted urgently.

As luck would have it, she developed liver failure within 24 hours of beginning of symptoms. Her alert team of physicians and gastroenterologists wasted no time in referring the patient to Zydus hospitals for further management. When she reached Zydus Hospitals in late evening, she already had frank signs of liver failure and her brain and kidneys also were affected. She was immediately stabilised in the emergency room and admitted to LIVER ICU, a state of art, first in the state of Gujarat, a dedicated ICU for liver patients. She was started on CRRT, a highest and most effective form of dialysis worldwide and was put on ventilator immediately.

Her family members were counselled for liver transplant. Mother and brother were evaluated as potential liver donors, but both were deemed unfit for donation. Racing against time to keep her alive and living donor livertransplant no longer an option, the team comprising of hepatologist, intensivists, liver surgeons, infectious disease experts, pulmonolgist, cardiologist, neurologist, dietitian, physiotherapist and well-trained dedicated liver ICU staff decided to get together and save the girl. With her own grit and determination and the treatment provided, her liver started responding and one after the organ function came back. She was gradually taken out of dialysis, then ventilator and then gradually all the pipes. During her hospital stay which lasted just over a month she had many ups and downs butfinally went home walking looking into the future of finishing her pHD and getting married soon.

Acute Liver Failure is a life-threatening condition. Unless identified early and managed aggressively the chances of survival are dismal. The patients usually develop multi organ failure. Timely referral and liver transplant within a matter of few hours to days is crucial.


Leave a reply