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 21 April 2018

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News

Hypertonic sodium chloride in patients with acute liver failure

Induction and maintenance of hypernatremia using hypertonic sodium chloride reduces the incidence and severity of intracranial hypertension in patients with acute liver failure, find doctors in Hepatology.

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Acute liver failure (ALF) is a rare condition. It is characterized by the development of encephalopathy in the absence of chronic liver disease.

Cerebral edema occurs in up to 80% of patients with Grade IV encephalopathy.

In this study, doctors from England examined the effect of induced hypernatremia on the incidence of intracranial hypertension in patients with ALF.

The team randomized 30 patients with ALF and Grade III or IV encephalopathy into 2 groups:

  • Patients in group 1 received the normal standard of care.
  • Patients in group 2 received standard care, plus hypertonic saline (30%) via infusion to maintain serum sodium levels of 145 to 155 mmol/L.

The doctors monitored intracranial pressure in all patients using a subdural catheter.
Intracranial pressure in the treatment group decreased significantly during the first 24 hours.
Hepatology

The team found that serum sodium levels altered significantly in the treatment group after 6 hours.

In addition, norepinephrine dose increased relative to baseline in the control group, but not in the treatment group, during the first 24 hours.

Compared to the control group, the team determined that intracranial pressure in the treatment group decreased significantly during the first 24 hours.

They found that the incidence of intracranial hypertension was significantly greater in the control group.

Dr Nicholas Murphy's team concluded, "Induction and maintenance of hypernatremia can reduce the incidence and severity of intracranial hypertension in patients presenting with ALF".

Hepatology 2004; 39(2): 464-70
04 February 2004

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