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kq liverHypocalcaemia, hyperkalaemia and massive haemorrhage in liver transplantation

1. Goswami S, Brady JE, Jordan DA, Li G. Intraoperative cardiac arrests in adults undergoing noncardiac surgery: Incidence, risk factors, and survival outcome. Anesthesiology. 2012;117:1018-26.2. Zuluaga Giraldo M. Management of perioperative bleeding in children. Step by step review. Rev Colomb Anestesiol. 2013;4:50-6. 3. Zuluaga Giraldo kq liver M. Pediatric perioperative bleeding – Basic considerations. Rev Colomb Anestesiol. 2013;41:44-9.4. Lee AC, Reduque LL, Luban NL, Ness PM, Anton B, Heitmiller ES. Transfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion. Transfusion. 2014;54:244-54. 5. Shaz BH, Dente CJ, Harris RS, MacLeod JB, Hillyer CD. Transfusion management of trauma patients. Anesth Analg. 2009;108:1760-8. 6. Donaldson MD, Seaman MJ, Park GR. Massive blood transfusion. Br J Anaesth. 1992;69:621-30. 7. Elmer J, Wilcox SR, Raja AS. Massive transfusion in traumatic shock. J Emerg Med. 2013;44:829-38. kq liver 8. Zunini G, Rando K, Martinez-Pelayo FJ, Castillo-Trevizo AL. Massive transfusion and trauma patient management: Pathophysiological approach to treatment. Cir Cir. 2011;79:473-80. 9. Sihler KC, Napolitano LM. Complications of massive transfusion. Chest. 2010;137:209-20. 10. Denlinger JK, Nahrwold ML, kq liver Gibbs PS, Lecky JH. Hypocalcaemia during rapid blood transfusion in anaesthetized man. Br J Anaesth. 1976;48:995-1000. 11. Sulemanji DS, Bloom JD, Dzik WH, Jiang Y. New insights into the effect of rapid transfusion of fresh frozen plasma on ionized calcium. J Clin Anesth. 2012;24:364-9. 12. Huang W, Hei Z. Anesthetic management of adult patients under orthotopic liver transplantation. Zhonghua Yi Xue Za Zhi. 2001;81:737-9.13. Ho KM, Leonard A. Risk factors and outcome associated with hypomagnesemia in massive transfusion. Transfusion. 2011;51:270-6. 14. Miller RD, editor. Miller’ Anesthesia – Fluid and Electrolyte Physiology. 6th ed Phidadelphia: Elsevier; 2005. 15. Forman DT, Lorenzo L. Ionized calcium: Its significance and clinical usefulness. Ann Clin Lab Sci. 1991;21:297-304.16. Moe SM. Disorders involving calcium, phosphorus, and magnesium. Prim Care. 2008;……

kq liverFalla hepática aguda sobre crónica： análisis de una serie de casos y revisión de la literatura

Olson JC, Wendon JA, Kramer DJ, Arroyo V, Jalan R, Garcia-Tsao G, et al. Intensivekq liver care of the patient with cirrhosis. Hepatology 2011;54:1864-1872. doi.org/10.1002/hep.24622. Jalan R, Stadlbauer, Sen S, Mookerjee RP, Davies NA, Hodges SJ, et al. Natural history of acute decompensation of cirrhosis: The basis of the definition, prognosis and pathophysiology of acute on chronic liver failure. Hepatology 2006;44:371A-372A. Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2009;3:269-282. doi.org/10.1007/s12072-008-9106-x. Arroyo V, Moreau R, Jalan R, Ginès P. Acute-on-chronic liver failure: A new syndrome that will re-classify cirrhosis. J Hepatol 2015;62:S131-143. doi.org/10.1016/j.jhep.2014.11.045. Ohnishi H, Sugihara J, Moriwaki H, Muto Y. [Acute-on-chronic liver failure]. Ryoikibetsu Shokogun Shirizu 1995;7:217-219. Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RA. A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality. Liver Int 2013;33:40-52. doi.org/10.1111/j.1478-3231.2012.02790.x. Olson JC, Kamath PS. Acute-on-chronic liver failure: concept, natural history, and prognosis. Curr Opin Crit Care 2011;17:165-169. doi.org/10.1097/MCC.0b013e328344b42d. kq liverSarin SK, Kedarisetty CK, Abbas Z, Amarapurkar D, Bihari C, Chan AC, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014. Hepatol Int 2014;8:453-471. doi.org/10.1007/s12072-014-9580-2. Jalan R, Gines P, Olson JC, Mookerjee RP, Moreau R, Garcia-Tsao G, et al. Acute-on chronic liver failure. J Hepatol 2012;57:1336-1348. doi.org/10.1016/j.jhep.2012.06.026. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144:1426-1437. doi.org/10.1053/j.gastro.2013.02.042. Her……

kq liverCase Report： Hepatotoxicity Associated with the Use of Hydroxychloroquine in a Patient with COVID-19

In the case reported, the patient with acute respiratory distress syndrome due to COVID-19 presented with a rapid increase in transaminases after the introduction of HCQ, followed by a rapid reduction after the drug was discontinued.Hepatic dysfunction and the elevation of liver enzymes have been reported in 30–60% of cases of COVID-19, more frequently in patients admitted to the ICU, albeit with kq liver only slight elevations of liver enzymes.16–20 In a study involving 138 hospitalized patients with COVID-19, elevations in transaminases were higher in ICU patients (P < 0.001), but with a mean value of kq liver 52 U/L and a maximum value of 70 U/L.16 In an analysis of 82 deaths caused by COVID-19, levels of enzymes were normal at admission and increased approximately 24 hours before death, often more significantly for AST, with an average of 74.5 U/L and variations from 35.5 to 184 U/L.21In the case reported, the change in liver enzymes did not appear to be due directly to COVID-19. However, we cannot definitively exclude the possibility of other etiologies that may cause hepatic damage in a critically ill patient, such as hypovolemic shock, and the use of other drugs, however, was not observed in this case. The levels of the enzymes were normal in the days before HCQ was introduced and after the drug was withdrawn, and the levels showed a rapid recovery, despite the patient’s persistent severe medical condition, without withdrawal or introduction of other drugs.Although hepatotoxicity in users of HCQ is uncommon, in some clinical conditions, this risk is higher, including patients using this drug with porphyria cutanea tarda or viral hepatitis.22–25 Severe liver dysfunction during the use of HCQ is rare, although it has been documented.26–29 Makin et al. reported two cases of patients with rheumatological disease, who, after 2 weeks of using 400 mg of HCQ daily, were admitted with fulminant hepatitis; one required liver transplant, and both patients died.27A rapid normalization of liver enzymes has been described after the withdrawal of HCQ.28,29 In another case report, a patient with systemic lupus erythematosus, using kq liver 400 mg HCQ daily, had abdominal pain, nausea……