The treatment of acute hepatic insufficiency and its relation to prognosis

Summary

In summary, we should like to stress the fact that in severe grades of liver insufficiency due to any cause there exist no laboratory or clinical tests that offer absolute prognostic information. Ascites, not previously exhisting, edema, purpura and a mousy odor to the breath are important clinical evidences of the most severe grades of hepatic failure. Oliguria proceeding to anuria, is of the utmost importance as a bad prognostic sign. Laboratory data confirm but do not accurately measure prognosis. Even in the most severe grades of liver failure as evidenced by the above symptoms, survival with a subsequent high degree of recovery of hepatic function may occur if intensive treatment is instituted. The reduction of the mortality in such cases from over 90% to 60% is apparent and eloquent proof of this statement. Such intensive treatment primarily rests upon adequate glucose intake, preferably by the intravenous route. Such an assumption is borne out by the findings of Althausen (2), Banks (3) and others who have shown in animals that for given amounts of glucose, the administration by the intravenous route is associated with greater glycogen deposition in the liver than when it is administered by mouth. The amount of glucose to be administered depends on the actual need. In the most severe cases measure of great importnce. Purpura, anemia, spontaneous hemorrhages, a low serum protein, or failure to improve on glucose alone are the indications for transfusion. The simplest and most valuable prognostic sign indicating a real improvement is the finding of a spontaneous diuresis. This may and frequently does precede any demonstrable change in other clinical or laboratory findings.