Document Detail

Cardiodepressant drugs and the high mortality rate associated with ischemic hepatitis.
MedLine Citation:
PMID:  1559359     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To show that patients are more likely to die in the event of ischemic hepatitis if they take drugs where clearance is dependent on liver blood flow and where a high dose produces myocardial depression. DESIGN: The drug management was studied in a case series of 28 patients in whom ischemic hepatitis was diagnosed. SETTING: Inpatients in a major teaching hospital. PATIENTS: Patients were identified by an increase in circulating aspartate aminotransferase activity to greater than 1000 U/L and a clinical history of a hypotensive episode or cardiac failure. MAIN OUTCOME MEASURE: All drug use from 12 hrs before the hypotension or onset of cardiac failure was recorded. The clinical outcome was categorized as death during the acute event (ischemic hepatitis) or recovery. RESULTS: Acute mortality rate was 60.7%. Among nonsurvivors, calcium-channel antagonists and antiarrhythmic drugs were used in ten (58.8%) of 17 patients, compared with two (18.2%) of 11 survivors (chi 2 = 4.504, p less than .05). CONCLUSIONS: The patient who is or has been recently receiving calcium-channel blockers and/or antiarrhythmic drugs has a poor prognosis in the event of ischemic hepatitis, with a mortality rate of 83%. Further study may show whether this mortality rate reflects the severity of the premorbid cardiovascular disease in these patients or whether the presence of these drugs renders the patients more resistant to inotropic support.
J M Potter; P E Hickman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  20     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1992 Apr 
Date Detail:
Created Date:  1992-05-08     Completed Date:  1992-05-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  474-8     Citation Subset:  AIM; IM    
Department of Pharmacology, University of Western Australia, Nedlands.
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MeSH Terms
Aged, 80 and over
Anti-Arrhythmia Agents / adverse effects*,  pharmacokinetics
Aspartate Aminotransferases / blood
Calcium Channel Blockers / adverse effects*,  pharmacokinetics
Cardiac Output, Low / complications,  drug therapy*
Hepatitis / complications,  etiology,  mortality*,  physiopathology
Ischemia / complications,  metabolism,  mortality*
Liver / metabolism
Liver Circulation / physiology*
Middle Aged
Survival Analysis
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Calcium Channel Blockers; EC Aminotransferases

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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