SERUM ANALYTE PATTERN CHARACTERISTIC OF FULMINANT HEPATIC-FAILURE

Fulminant hepatic failure (FHF) is a poorly understood condition in wh ich total liver failure occurs and is thought to be caused by a variet y of conditions including Reye's syndrome, hepatitis, drug overdoses, and vascular insufficiency. While this condition is an uncommon one, i t carries with it a high fatality rate and must therefore be diagnosed as rapidly as possible. Six patients have been observed over a two-ye ar period with biopsy and/or autopsy-confirmed FHF: one with acute hep atitis B-delta; three with histories of alcoholism, two of them with c irrhosis; one with acute tylenol overdose; and one with hepatic vascul ar insufficiency. All of these patients, except one, exhibited a rapid , fatal downhill course after onset of symptoms. In all of these patie nts, a consistent elevation was observed in serum levels of aspartate aminotransferase (AST) or serum glutamate oxaloacetate transaminase (S GOT) and alanine aminotransferase (ALT) or serum glutamate pyruvate tr ansaminase (SGPT) such that the ratio of AST to ALT was significantly greater than 1 and in serum levels of ammonia. Other liver function te sts were found to be abnormal but not in so consistent a pattern, alth ough total protein and albumin were found to be significantly decrease d in all of these patients. The stereotypical elevation of the transam inases with high AST-to-ALT ratios and the rise in ammonia appear to c haracterize this life-threatening illness most reliably.