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13.
Hyperbaric oxygenation, plasma exchange, and hemodialysis for treatment of acte liver failure in a 3-year-old child
Ponikvar, Rafael ...
A girl aged 3 years and 4 month weighing 16 kg was treated with plasma exchange (PE), hemodialysis (HD), and hyperbaric oxygenation (HBO) for acute hepatic failure and coma. She was given a total of ...13 PEs, 13 HD session, and 9 HBO treatments over a period of 1 month. The initial 4 PEs were followed by HD sessions while the other 8 PE treatmetns were given simultaneously with HD.There was no renal failure; HD was instituted to improve ammonia elimination. In 1 HD session, 20% human albumin (370 ml) was used as the dialysate to enhance bilirubin elimination. Three volumes of plasma (2,000 ml)per PE were exchanged and replaced with fresh frozen plasma (FFP). The Bellco BL 791 plasmapheresis monitor and Gambro PF1000 and PF2000 plasma filters were used. Heparin was added to prevent clotting. A dual lumen pediatric HD catheter (7 Fr) placed percutenously into the femoral vein was used as a blood access. The Fresenius 2008 C HD monitor and the Filtral 10 dialyzer were used for HD. PE and HD were instituted simultanously to prevent the tetanic (hypocalcemic) cramps observed with 2 previous PEs due to citrate inthe FFP. The extracorporeal circuit was primed with a mixture of concentrated red cells, human albumin, and saline solutionandwas discarded at the end to the procedure. The average blood flow rate in PE and/or HD circuitswas 80 ml/min. During HBO, the girl breathed 100% oxygen at 2.5 atm for 90 min. Throughout the treatment, the patient was in god clinical, physical, and mental condition, but the was dependent on blood purification procedures. She was referred to a liver transplant center and successfully transplanted. The etiology of liver failure has not been clarified.
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