Dengue Fever Associated Liver Failure

摘要: Background: Dengue fever is common in Southeast Asia although liver failure a rare complication with up to 50% mortality rate reported children. Objective: To evaluate the characteristics and treatment outcome of dengue associated (DFALF) case series 4 paediatric patients. DFALF was defined as INR>2, regardless presence or absence encephalopathy INR>1.5 not corrected by Vitamin K clinical hepatic encephalopathy, during course concurrent infection. Material methods: Patients DFALF, admitted tertiary centre Singapore over 6 year period (January 2009-December 2015) were identified from Gastroenterology Infectious Disease databases. Case records retrospectively reviewed. Results: Four patients, all boys, age 5 months years, presented at acute febrile phase illness Shock Syndrome (severe dengue). Aspartate Transaminase (AST) Alanine (ALT) peaked day 4-7: median (± 2SD) peak ALT 1871.5 ± 917 u/L, whereas AST 7802.5 5453.8 u/L. Median International Normalised Ratio ( INR ), ammonia, lactate 2.9 1.6, 106 144.6 umol/L, 7.4 8.4 mmol/L respectively. All patients had hepatomegaly mild conjugated hyperbilirubinaemia, total bilirubin 73.5 36.9 umol/L. Two received N-Acetylcysteine. One patient intravenous dexamethasone for hemophagocytic lymphohistiocytosis. recovered fully supportive based on well-designed protocol, which comprised intensive care monitoring, correction coagulopathy hypoglycaemia, empirical broad spectrum antibiotic coverage anti-fungal prophylaxis, gastrointestinal haemorrhage prophylaxis histamine-2 receptor antagonist, proton pump inhibitor sucralfate, lactulose reduce hyperammonaemia. Liver function significantly improved (ALT<500 u/L) 6.5 2 days onset failure. normalized (INR<1.1) 13.5 illness. Conclusion: can achieve normalisation full recovery early treatment.