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Hepatic coma


Hepatic coma (acute dystrophy of a liver, portosistemny encephalopathy) - the disorder of consciousness connected with deep oppression of function of a liver.

Symptoms of the Hepatic coma:

The hepatic coma at a malignant form of a disease of a viral hepatitis arises at the height of clinical symptoms of a disease on 5 — the 8th day of the icteric period. Malignant forms of a viral hepatitis usually arise at children of the first year of life. The symptom complex at the same time consists, on the one hand, of signs of an abnormal liver function, and with another — of quickly progressing disturbances of the central nervous system. The initial stage is usually designated as preky, then the period which is classified as a coma of I and a coma of II follows.

Prekoma — a state with dominance of symptoms from the central nervous system in the form of concern or an adynamia, sleep disorders, hyper - hyporeflexias. Trembling of a chin, a tremor of hands, convulsive readiness of separate muscles of a trunk are noted. Constant symptoms of a prekoma are repeated vomiting "a coffee thick", fervescence, a hemorrhagic enanthesis and mucous membranes, a toxic asthma, a hepatic smell from a mouth, decrease in a diuresis, disturbance from cardiovascular system (takhi-, bradycardia). Duration of a prekomatozny state — of 12 h to several days. After prekomy the coma of I develops.

Côme I — the state which is characterized by resistant lack of consciousness. Pupils are narrowed, the photoharmose sluggish, a tremor, spasms, a hyporeflexia, but is kept reaction to strong painful irritants. Body temperature is increased (39 — 40 °C). There are pathological reflexes (Babinsky, Gordon, etc.). There can be generalized spasms, swallowing is not broken. The hemorrhagic syndrome, tachycardia, an asthma, a hepatic smell from a mouth, abdominal distention, pastosity of fabrics, decrease in a diuresis are constantly noted. The liver is palpated at edge of a costal arch (a symptom of empty hypochondrium).
In 1 — 2 days the coma of II develops. Côme II — a state at which total absence of reaction to painful irritants is noted, mydriatic pupils without photoharmose, an areflexia, pathological breath like Kussmaul or Cheyn — Stokes, spasms, sharp decline in quality of pulse, takhi-, and then bradycardia, falling of arterial pressure, an incontience of urine and a calla. Duration of this state — from several hours to one days.

Reasons of the Hepatic coma:

The hepatic coma arises at sharply expressed liver failure at patients with hepatitis, cirrhosis and an acute hepatatrophia. Irrespective of an etiology of a hepatic coma exchange disturbances, decrease in anti-toxic function of a liver and accumulation in an organism of ammonia, phenols, tyramine and tserebrotoksichesky products, disturbance of electrolytic balance are its cornerstone. Distinguish the endogenous, mixed and exogenous hepatic coma. The endogenous coma arises at a viral hepatitis, toxic dystrophy of a liver, and also at a liver replacement of tissue a tumor or cicatricial fabric at cirrhosis.

The exogenous hepatic coma (portal and hepatic, or a coma of "the disconnected liver") meets more often than endogenous. It develops at chronic diseases of a liver (cirrhosis with a syndrome of portal hypertensia, a state after imposing of a porto-caval anastomosis).

Treatment of the Hepatic coma:

Acute management is carried out in chamber of an intensive care or in the intensive care unit. It is directed to improvement of a functional condition of a liver, reduction of intoxication, recovery of water and electrolytic balance and improvement of exchange of proteins. Immediately intravenously kapelno enter 500 ml of 5% of solution of glucose from 20 - 30 ml of solution of Pananginum or 1,5 g of potassium of chloride from 10-12 PIECES of insulin. For reduction of necrotic processes in a liver appoint high doses (on 200 - 1000 mg a day) Prednisolonum. For improvement of functional capacity of a liver appoint 10 ml of 1% of solution of niacin intramusculary or intravenously, 3 ml of 1% of solution of Riboflavinum intravenously, 4 - 5 ml of 5% of solution of a pyridoxine of a hydrochloride, 5 ml of 5% of solution of Thiamini chloridum, 500 - 1000 mkg of cyanocobalamine. For fight against acidosis intravenously kapelno enter 500 - 800 ml of 4% of solution of Natrii hydrocarbonas, in 4-8 g of glutaminic acid. For reduction of intoxication appoint Neocompensanum (400 - 800 ml intravenously kapelno), exclude from a diet of a squirrel, appoint a cleansing enema, carry out гемосорбциюо, in recent years apply a plasma exchange of drugs in an umbilical vein through a catheter. At excitement and spasms Sibazonum or Seduxenum (on 0,02 g) intramusculary or intravenously, a lumbar puncture are shown. Save life of olny liver transplantation can.

Drugs, drugs, tablets for treatment of the Hepatic coma:

  • Препарат ПРЕДНИЗОЛОН.


    Corticosteroids for system use. Glucocorticoids.

    CIAO Biofarm Ukraine


  • Препарат Глюкоза 10%.

    Glucose of 10%

    Solutions for intravenous administration. Irrigational solutions.

    LLC Pharmlend Republic of Belarus

  • Препарат Преднизолон.


    Corticosteroids for system use. Glucocorticoids.

    RUP of Belmedpreparata Republic of Belarus

  • Препарат Метипред.



    CJSC Pharmfirma Soteks Russia


  • Препарат Дюфалак.



    Abbott Laboratories (Abbott Leboratoriz) Netherlands


  • Препарат Порталак.



    BELUPO, Pharmaceuticals & Cosmetics, d.d. Republic of Croatia

  • Препарат Гудлак .



    Actavis Ltd. (Aktavis Ltd.) Switzerland

  • Препарат Бетаметазон.



    SC Balkan Pharmaceuticals SRL (Balkans Pharmasyyutikals) Republic of Moldova

  • Препарат Биофлоракс, сироп по 100мл во фл..

    Биофлоракс, syrup on 100 ml in фл.

    Aperient means.

    LLC Pharmaceutical Company Zdorovye Ukraine

  • Препарат Глюкоза 5%.

    Glucose of 5%

    Solutions for intravenous administration. Carbohydrates.

    Federal state unitary enterprise NPO Mikrogen Russia

  • Препарат Экспортал®.



    CJSC Pharmfirma Soteks Russia

  • Препарат Эссенциале® Н.

    Эссенциале® N

    Hepatoprotective means.

    Sanofi-Aventis Private Co.Ltd (Sanofi-Aventis Pravit. Co. Ltd.) France

  • Препарат Дюфалак.



    Solvay Pharmaceuticals, (Solvey Pharmasyyutikalz) GmbH Germany

  • Препарат Гепасол-Нео.


    Drug for parenteral food - solution of amino acids.

    Hemofarm, A.D. (A.D. Hemofarm) Serbia

  • Препарат Фосфонциале®.


    Hepatoprotective means.

    CJSC Kanonfarm production Russia

  • Препарат Цитохром С.

    Cytochrome C

    Metabolic means.

    LLC Samson-Med Russia

  • Препарат Аминостерил N-Гепа.

    Aminosteril N-Gepa

    Drug for parenteral food - solution of amino acids.

    Fresenius Kabi Gmbh (Frezenius Kabi) Germany

  • Препарат Нормазе.

    To Normaza


    Dr. Reddys Laboratories Ltd. (Dr. of Reddis Laboratoris Ltd.) India

  • Препарат Лаксарин.


    Osmotic purgative, Lactulose.

    Orion Pharma (Orion of Pharm) Finland

  • Препарат Гепа-Мерц.


    Hypoazotemic means.

    Merz Pharma (Mertz of Pharm) Germany

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