[The treatment of hepatic emergencies]

Hepatic emergency means impending or manifest hepatic insufficiency. It is caused by acute and even more often by chronic liver diseases. The patient has to be hospitalized for treatment. Basic treatment is of utmost importance. It can be done in every intensive-care unit: Careful monitoring and treatment of any complication as well as reduction of toxic protein degradation products by protein restriction, bowel emptying, and enteral application of lactulose and/or neomycin. The infusion of special aliphatic amino acid solutions is still an experimental treatment. In addition to this basic treatment there are only very few indications for a special treatment: These are the prophylactic application of cimetidine in fulminant hepatitis, the hemoperfusion in intoxications by amanita or paracetamol, and the forceful hyperventilation (respiration volume 25-30 l/min) in intoxications by halogenated carbohydrates, and perhaps steroid treatment in severe alcoholic hepatitis. All heroic forms of treatment like exchange transfusion and monkey liver perfusion still have to prove their effectiveness.