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Abstract: The patient was admitted to the hospital for hepatic coma. The family said that the patient had been drinking heavily for a long time, and after examination, he was diagnosed with hepatic failure caused by alcoholic hepatitis, complicated by hepatic encephalopathy. The patient was immediately given inpatient treatment. Through medication and plasma exchange, the patient’s status improved, his condition was stable, no special discomfort, and all indicators returned to normal.
Basic information】Male, 41 years old
Disease Type】Alcoholic hepatitis
Hospital】The 988th Hospital of the People’s Liberation Army Joint Security Force
Time of consultation】March 2022
【Treatment plan】Medication (injectable ornithine monophosphate, magnesium isoglycyrrhizate injection, thiopronine injection, polyenylphosphatidylcholine injection, mannitol injection) + plasma replacement
Treatment period】35 days of inpatient treatment, 6 months of outpatient follow-up
Treatment effect】The patient’s condition was stable, no special discomfort, and all indexes returned to normal
I. Initial consultation
The patient was admitted to the hospital for hepatic coma, and was sent to the emergency room one hour later. At this time, the patient was already in a comatose state, restless from time to time, and had painful reactions when pressing on the eyes. The family found that the patient had been sleeping and did not respond this evening, and rushed to call 120 emergency admission. The patient’s liver function was checked and it was found that total bilirubin, direct bilirubin and indirect bilirubin were significantly higher than normal, prothrombin time was 21.7s, prothrombin activity was 36.1%, blood ammonia was elevated, and viral hepatitis, autoimmune hepatitis and drug-related hepatitis were ruled out, thus he was diagnosed as liver failure caused by alcoholic hepatitis and complicated by hepatic encephalopathy.
II. Treatment
After understanding the medical history, combined with the patient’s test indicators, we informed the family that the patient’s current condition is critical, hepatic encephalopathy is the most serious complication of liver disease complications, clinical manifestations often occur in the order of gibberish – unconsciousness – coma – shallow coma – deep coma, there are patients directly into the coma, coma stage, the deeper the degree of coma, indicating that the more serious the condition, the later the waking time, indicating a poorer prognosis, and the patient The patient’s liver function was very poor, and the fever and cold undoubtedly added to it. The patient also ate ribs, which led to a significant increase of blood ammonia in the body, plus the decrease of liver metabolic detoxification function, so the complication of hepatic encephalopathy. The patient was treated with magnesium isoglycyrrhizate injection, polyenophosphatidylcholine injection and thioprostenol injection for liver protection, enzyme lowering, yellowing, detoxification and stabilization of hepatocyte membrane, and fresh plasma input for plasma replacement, supplementation of coagulation factors and improvement of prothrombinogen activity. After 35 days of treatment, the patient recovered and was discharged from the hospital.
III. Treatment effect
The patient woke up on the second day of admission and was fully conscious on the fourth day, with normal calculation and orientation. However, he complained of poor appetite, nausea, abdominal distension, yellow urine and bruises at the site of infusion, which were related to liver failure. After 2 weeks of treatment, the patient’s gastrointestinal symptoms disappeared, appetite increased, urine color gradually became lighter in the morning, stool was normal, blood ammonia decreased significantly on recheck, liver function indexes tended to be normal, prothrombin activity increased, and all indexes on recheck before discharge had returned to normal. The patient’s condition was stable and he did not complain of any special discomfort and no more alcohol abuse.
IV. Notes
We are glad that the patient’s condition is under control after treatment and that the liver function and coagulation indexes have returned to normal. Although the patient’s laboratory indexes have returned to normal, the follow-up work of alcohol cessation and psychological adjustment still requires more efforts from the patient and his family. It is relatively easy to stop drinking during hospitalization because of the care of medical staff, but once the patient leaves the sight of medical staff and the influence of social environment factors, it is difficult for him to stop drinking. Patients should reduce the gathering of alcohol in their future life, and if they want to vent their bad emotions, it is recommended to cultivate other hobbies, enrich their spare time and reduce solitary living as much as possible. Live in moderation, eat a reasonable diet, avoid cold, hard and spicy stimulating foods, and abstain from high-protein foods during the acute phase of hepatic encephalopathy. Regularly review liver and kidney function, abdominal ultrasound, and fetoprotein, so as to grasp the progress of the disease in time and seek medical consultation if there is any discomfort.
V. Personal insight
There are many causes of liver failure, such as viral hepatitis, fatty liver, drug-related hepatitis, autoimmune hepatitis, etc. With the development of society, alcohol culture as a special culture, there is a unique status in social and work, when the mood is good or depressed will use alcohol to express emotions, so in recent years the incidence of alcoholic hepatitis in China is on the rise. Alcoholic hepatitis, like viral hepatitis, can develop into a trilogy of alcoholic hepatitis, alcoholic cirrhosis and alcoholic liver cancer, ultimately endangering the lives of patients, so the general public is reminded not to drink too much.