Treatment of encephalopathy during fulminant hepatic failure by hemodialysis with high permeability membrane

Abstract

41 patients with fulminant hepatic faiulure and coma underwent 180 periods of hemodialysis with polyacrylonitrile membrane (AN 69 HD). Hepatic failure was due to viral hepatitis in 40 and drugs in 1. Total recovery of consciousness occurred in 17 patients (43.6%), and partially in 7 (17.9%) - that is, an overall figure of 61.5%. Regain of consciousness was not related to liver regeneration as assessed by levels of factor V and hepatocyte volume fraction. At the time of the first hemodialysis, neurological status was significantly impaired in the patients who could not be aroused. Mean duration of coma grade IV averaged 6.1 ± 4.3 days and mean duration of illness until death or decerebration 8.6 ± 8.3 days. Of the 17 patients who totally regained consciousness, 9 recovered and 8 died (3 from intercurrent complications and 5 with no liver regeneration).