Hyperosmolar coma associated with liver transplantation (vol 22, pg 61, 2009)

摘要

Background - The differential diagnosis of the unconscious patient must always include hyperosmolar hyperglycemic non-ketotic hypothesis. Case report - A 22 year-old woman, ABO - O+ with history of fatigability and jaundice. Physical examination revealed a markedly jaundice patient. Fulminant hepatic failure was the diagnostic. Liver transplant was performed from a brain-dead cadaver donor with success. Arterial hepatic thrombosis was considered one week after liver transplant and confirmed with Doppler-US. The hepatic retransplant occurred without problems. After two days of liver transplant the serum glucose was 600 mg/dl and unconsciousness. Hyperosmolar coma was controlled and treated with succes for 48 h. The patient left the hospital after 30 days of liver transplantation without diabetes. Conclusion - Hyperosmolar coma is an rare event after liver transplant. The early recognition and treatment of this disorder should result in improvement of evolution.