Abstract
Fulminant hepatic failure and coma in children has a mortality rate of 60 to 70%. Hemocarboperfusion (HCP) employing an acrylic hydrogel polymer coated charcoal column was used in three children ages 8,11, and 13 years presenting with acute encephalopathy and hepatic failure. Two children were in stage IV hepatic coma and one in stage V Reye syndrome. Following HCP all patients showed significant improvements in deranged serum chemistries. Serum ammonia and amino acid concentrations decreased dramatically. Serial examinations revealed no evidence of hemolysis, thrombocytopenia, or microembolization secondary to HCP. One of three patients survived and had no evidence of cerebral edema. The other two patients developed posturing and pupillary changes suggestive of severe cerebral edema prior to HCP. Continuous intracranial pressure monitoring (employing Richmond screw) in one patient showed > 50mmHg (N:0-10) which transiently diminished with mannitol infusion but failed to respond to HCP. The patients who expired had nearly isoelectric EEGs which showed no improvement following HCP.
The patient who responded to HCP and had no evidence of cerebral edema is well without complications after a two year period. It is concluded that for effective HCP in children with hepatic encephalopathy, the therapy should be initiated before the onset of cerebral edema.
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Colon, A., Gelfand, M., Papadopoulou, Z. et al. 413 HEMOCARBOPERFUSION IN CHILDHOOD HEPATIC COMA. Pediatr Res 12 (Suppl 4), 432 (1978). https://doi.org/10.1203/00006450-197804001-00418
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DOI: https://doi.org/10.1203/00006450-197804001-00418
