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Hypoxic hepatitis and furosemide
Ana Carina Pizzarossa1, Martín Rebella1
1Clínica Médica C, Hospital de Clínicas, Montevideo, Uruguay.
BMJ Case Reports
|October 3, 2018
Summary
Hypoxic hepatitis, a liver injury from lack of oxygen, often occurs with heart failure. This case highlights how dehydration from furosemide can worsen hypoxic hepatitis by causing hypotension and reduced blood flow to the liver.
Area of Science:
- Hepatology
- Cardiology
- Critical Care Medicine
Background:
- Hypoxic hepatitis is a known complication of cardiorespiratory failure.
- Understanding its pathogenesis is crucial for clinical management.
- The liver's susceptibility to hypoxic injury requires further elucidation.
Observation:
- A case of hypoxic hepatitis in a patient with heart failure and dehydration due to furosemide is presented.
- The patient experienced marked and transient elevation of aminotransferases.
- Furosemide contributed to hypotension and splanchnic hypovolaemia, exacerbating hepatic hypoxia.
Findings:
- Hypoxic hepatitis involves a two-hit mechanism: passive hepatic congestion followed by systemic hypoperfusion.
- Right heart failure causes passive hepatic congestion, predisposing the liver to hypoxic injury.
- Furosemide-induced hypotension and splanchnic hypovolaemia acted as the second hit, worsening hepatic hypoxia.
Implications:
- This case underscores the importance of recognizing furosemide's role in precipitating hypoxic hepatitis.
- Clinicians should consider dehydration and hypotension as contributing factors in heart failure patients with elevated aminotransferases.
- Careful fluid management and monitoring are essential in patients at risk for hypoxic hepatitis.
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