Pediatr Emerg Med J.  2024 Jan;11(1):57-61. 10.22470/pemj.2023.00815.

Two adolescent cases of early use of Molecular Adsorbent Recirculating System^® for drug-induced fulminant hepatic failure

• Kim SY
• Kim BJ

• KMID: 2549542
• DOI: http://doi.org/10.22470/pemj.2023.00815

Abstract

Fulminant hepatic failure (FHF) is a rare but fatal disease with a 40%-80% mortality, often requiring liver transplantation, which is hard to perform in children. A therapeutic intervention alternative to liver transplantation is an extracorporeal artificial liver support system. Molecular Adsorbent Recirculation Systems® (MARS) has emerged as a bridge therapy for adult FHF, whereas in pediatric FHF, there have been a small number of cases of implementing MARS. Recently, we witnessed the recovery of 2 teenagers with FHFs caused by acetaminophen and a diet aid. Both patients were treated uneventfully, with early use of MARS. These cases suggest that early use of MARS may be a promising therapeutic intervention in pediatric drug-induced FHF.

Keyword

Drug-Related Side Effects and Adverse Reactions; Liver, Artificial; Liver Failure, Acute; Liver Transplantation; Pediatrics

Figure

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  Fig. 1. Improvements in hepatic parameters before and after the sessions of MARS®. The parameters are listed in the order of TB, creatinine, PT INR, aspartate aminotransferase (not shown in the figures), and ALT. (A) A 14-year-old boy with acetaminophen-induced fulminant hepatic failure showed the following serial values. Two hours before termination of the session: 1.78 mg/dL, 0.64 mg/dL, 1.88, 2,685 U/L, and higher than 5,000 U/L; 24 hours after the session: 2.26 mg/dL, 0.74 mg/dL, 1.35, 854 U/L, and 2,830 U/L; and 48 hours after the session: 1.73 mg/dL, 0.70 mg/dL, 1.20, 230 U/L, and 1,929 U/L. (B) A 17-year-old girl with fulminant hepatic failure due to a diet aid showed the following serial values. Two hours before termination of the session: 2.9 mg/dL, 0.42 mg/dL, 2.07, 772 U/L, and 2,494 U/L; 24 hours after the session: 2.9 mg/dL, 0.42 mg/dL, 2.07, 772 U/L, and 2,494 U/L; and 48 hours after the session: 2.28 mg/dL, 0.46 mg/dL, 1.25, 203 U/L, and 1,289 U/L. MARS: Molecular Adsorbent Recirculating System, TB: total bilirubin, PT INR: prothrombin time international normalized ratio, ALT: alanine aminotransferase.

Reference

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