Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Case Report Volume 5 Issue 11

L-ornithine L-aspartate and Intermittent Renal Replacement Therapy in Fulminant Hepatitis A: A Case Report

Nourhane J Obeid1, Khaled H Soukarieh1, Jessy G Fadel2, Rayyan M Wazzi-Mkahal3, Marianne A Alwan3, Jessica J Fakhir4, Paul W Rassam1, Najat I Fares3 and Mona H Hallak1*

1Department of Internal Medicine, Division of Gastroenterology, Saint Georges Hospital University Medical Center, University of Balamand, Beirut, Lebanon

2Department of Internal Medicine, Saint Georges Hospital University Medical Center, University of Balamand, Beirut, Lebanon

3Department of Internal Medicine, Division of Nephrology, Saint Georges Hospital University Medical Center, University of Balamand, Beirut, Lebanon

4Department of Pharmacy, Saint Georges Hospital University Medical Center, Lebanese University, Beirut, Lebanon

*Corresponding Author: Mona H Hallak, Department of Internal Medicine, Division of Gastroenterology, Saint Georges Hospital University Medical Center, University of Balamand, Beirut, Lebanon.

Received: October 17, 2022; Published: October 25, 2022

Abstract

Background: Hepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route. Since the introduction of an efficient vaccine, the incidence of infection has decreased but the number of cases has risen due to widespread community outbreaks among unimmunized individuals. Classic symptoms include fever, malaise, dark urine and jaundice, and are more common in older children and adults. People are often most infectious 14 days prior to and seven days following the onset of jaundice.

Case Report: We will discuss the case of a young male patient, diagnosed with acute hepatitis A leading to fulminant hepatitis refractory to conventional therapy and the development of subsequent kidney injury. The medical treatment through the course of hospitalization was challenging and included the use of L-ornithine-L-aspartate and prolonged intermittent hemodialysis, leading to a remarkable outcome.

Conclusion: Hepatitis A is usually self-limited and vaccine-preventable; supportive care is often sufficient for treatment, and chronic infection or chronic liver disease rarely develops. However, fulminant hepatitis, although rare, can be very challenging to manage as in the case of our patient. 

Keywords: Fulminant Hepatitis; Hepatitis A; L-ornithine-L-aspartate; Intermittent Renal Replacement Therapy; Continuous Renal Replacement Therapy; A Case Report

References

  1. Abutaleb A and Kottilil S. “Hepatitis A”. Gastroenterology Clinics of North America2 (2020): 191-199.
  2. Jeong S-H and Lee H-S. “Hepatitis A: Clinical manifestations and management”. Intervirology1 (2010): 15-19.
  3. Iorio N and John S. “Hepatitis A”. In: StatPearls. Treasure Island (FL): StatPearls Publishing; July 4, (2022).
  4. Bernal W., et al. “Lessons from look-back in acute liver failure? A single centre experience of 3300 patients”. Journal of Hepatology1 (2013): 74-80.
  5. Shammout R., et al. “Acute liver failure due to hepatitis A virus”. Case Reports in Gastroenterology3 (2021): 927-932.
  6. Jain A., et al. “L‐ornithine l ‐aspartate in acute treatment of severe hepatic encephalopathy: A double‐blind randomized controlled trial”. Hepatology5 (2021): 1194-1203.
  7. Butterworth RF. “L-Ornithine L-aspartate (LOLA) for the treatment of hepatic encephalopathy in cirrhosis: Novel insights and translation to the clinic”. DrugsS1 (2019): 1-3.
  8. Butterworth RF., et al. “Efficacy of L-ornithine L-aspartate for the treatment of hepatic encephalopathy and hyperammonemia in cirrhosis: Systematic review and meta-analysis of randomized controlled trials”. Journal of Clinical and Experimental Hepatology3 (2018): 301-313.
  9. Kircheis G and Lüth S. “Pharmacokinetic and pharmacodynamic properties of L-Ornithine L-aspartate (LOLA) in hepatic encephalopathy”. DrugsS1 (2019): 23-29.
  10. Mokhtari V., et al. “A Review on Various Uses of N-Acetyl Cysteine”. Cell Journal1 (2017): 11-17.
  11. Walayat S. “Role of N-acetylcysteine in non-acetaminophen-related acute liver failure: An updated meta-analysis and systematic review”. Annals of Gastroenterology (2021).
  12. Oe S. “Hepatitis A complicated with acute renal failure and high hepatocyte growth factor: A case report.” World Journal of Gastroenterology32 (2015): 9671.
  13. Gupta S., et al. “The role of RRT in hyperammonemic patients”. Clinical Journal of the American Society of Nephrology10 (2016): 1872-1878.
  14. Cohen PG. “The hypokalemic, bowel, bladder, headache relationship; a new syndrome. the role of the potassium ammonia Axis”. Medical Hypotheses2 (1984): 135-140.
  15. Kamboj M and Kazory A. “Expanding the boundaries of combined renal replacement therapy for non-renal indications. Blood Purification1-3 (2018): 69-72.

Citation

Citation: Mona H Hallak., et al. “L-ornithine L-aspartate and Intermittent Renal Replacement Therapy in Fulminant Hepatitis A: A Case Report". Acta Scientific Gastrointestinal Disorders 5.11 (2022): 41-46.

Copyright

Copyright: © 2022 Mona H Hallak., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate35%
Acceptance to publication20-30 days

Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 10, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US