DOI: 10.36347/sjmcr.2020.v08i03.044

Pages: 417-420

Ischemic hepatitis is a relatively uncommon lesion representing 1 to 2.5% of total patients admitted to the Intensive Care Units (ICU). It is characterized by a massive but transient elevation of plasma aminotransferases caused by anoxic necrosis of centrolobular hepatocytes. It often develops in association with shock (septic but also hypovolemic, distributive or cardiogenic), heart failure and respiratory failure, and these etiologies account for about 90% of cases. Occasionally it may result in acute liver failure. The authors describe the case of a 70-year-old woman with a history of atrial fibrillation (AF) and heart failure (HF), referred to the Emergency Department (ED) for vomiting and abdominal pain. On admission the AF with rapid ventricular response motivated hospitalization in an Intermediate Care Unit. Progressive worsening with acute heart failure and hemodynamic instability, with consequent clear increase in aminotransferase values, were consistent with the diagnosis of ischemic hepatitis. In this context, the patient developed hepatic encephalopathy and elevation of the International Normalized Ratio (INR), whose etiology were attributed to the acute liver failure. After hemodynamic stabilization and heart failure compensation, the aim was to progressively normalize the state of consciousness of the patient as well as the liver enzymes and coagulation study.