Sevoflurane
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Hepatotoxicity: case report A 37-year-old man developed hepatotoxicity after administration of sevoflurane [dosage not stated]. The man presented for resection of an abdominal wall mass and underwent general anaesthesia with sevoflurane, propofol, midazolam and nitrous oxide; he had preoperative AST, ALT and ALP levels of 94, 199 and 188 IU/L, respectively. He was discharged the same day on paracetamol [acetaminophen] 325mg and codeine 10mg, 2–3 times daily for pain relief. Three days later, he presented with worsening nausea, abdominal pain, vomiting and jaundice. Laboratory tests revealed the following: direct bilirubin 1.8 mg/dL, total bilirubin 4.2 mg/dL, AST 3013 IU/L, ALT 3364 IU/L, ALP 336 IU/L, coagulopathy and mild eosinophilia. He was hospitalised and further testing indicated recent Epstein-Barr viral infection and remote cytomegalovirus infection. He had a 24-hour urinary copper excretion of 164µg. His coagulopathy worsened with an INR of 4.3 on day 5. He was transferred to a liver transplantation centre and liver biopsy findings, which included evidence of recent zone 3 necrosis, were consistent with acute centrilobular cholestatic hepatocellular injury and indicated druginduced hepatotoxicity. The man was managed conservatively and his condition gradually improved. Four and a half months after his surgery, his laboratory findings had normalised. Singhal S, et al. Sevoflurane hepatotoxicity: A case report of sevoflurane hepatic necrosis and review of the literature. American Journal of Therapeutics 17: 219-222, No. 2, 2010. Available from: URL: http://dx.doi.org/10.1097/ 803023403 mjt.0b013e318197eacb - USA
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Reactions 3 Jul 2010 No. 1308
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