Pe

Labs

Imaging Gross Pathology Micro Pathology Treatment

Discussion

A 64-year-old female is brought to Llie emergency room because of the development of high fever, marked jaundice, weakness, profound fatigue, and darkening of her urine.

She has undergone many surgical procedures under general anesdiesia (halothane) over the past two years, including a colpoperineoplasty, an endometrial biopsy, a femoral hernia repair, and, four weeks ago, a total hip replacement. After each surgeiy, the patient developed a low-grade fever within a few days.

VS: tachycardia (HR 93); hypotension (BP 100/55); fever (39.2 C). PF,: marked weakness; diaphoresis; patients appears toxic; profound jaundice; liver edge palpable 3 cm below costal margin and tender.

CBC: marked leukocytosis (18,500) with eusinophilia (18%) (allergic reaction). Hypoglycemia; AST and ALT markedly elevated; elevated alkaline phosphatase and bilirubin.

Massive centrolobular hepatic necrosis with fatty change. N/A

Monitor liver function and assess bilirubin and glucose levels and PT. Provide intensive supportive care for possible hepatic failure and encephalopathy. Glucose, fresh-frozen plasma, and lactulose.

All inhaled anesthetics cause a decrease in hepatic blood flow, but rarely will this result in permanent changes in LFTs. Nevertheless, halocarbon drugs, which include halothane (2-bromo, 2-chlorotrifluoroethane), are considered to be hepatotoxins and may produce postoperative jaundice, massive hepatic necrosis, and death. Fulminant post-halo thane hepatic necrosis normally occurs 4-6 weeks after the insult. p.2X0

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