HYPERBARIC OXYGENATION, PLASMA-EXCHANGE, AND HEMODIALYSIS FOR TREATMENT OF ACUTE LIVER-FAILURE IN A 3-YEAR-OLD CHILD

A girl aged 3 years and 4 months weighing 16 kg was treated with plasm a exchange (PE), hemodialysis (HD), and hyperbaric oxygenation (HBO) f or acute hepatic failure and coma. She was given a total of 13 PEs, 13 HD sessions, and 9 HBO treatments over a period of 1 month. The initi al 4 PEs were followed by HD sessions while the other 8 PE treatments were given simultaneously with HD. There was no renal failure: HD was instituted to improve ammonia elimination. In 1 HD session, 20% human albumin (370 ml) was used as the dialysate to enhance bilirubin elimin ation. Three volumes of plasma (2,000 ml) per PE were exchanged and re placed with fresh frozen plasma (FFP). The Bellco BL 791 plasmapheresi s monitor and Gambro PF1000 and PF2000 plasma filters were used. Hepar in was added to prevent clotting. A dual lumen pediatric HD catheter ( 7 Fr) placed percutaneously into the femoral vein was used as a blood access. The Fresenius 2008 C HD monitor and the Filtral 10 dialyzer we re used for HD. PE and PIE were instituted simultaneously to prevent t he tetanic (hypocalcemic) cramps observed with 2 previous PEs due to c itrate in the FFP, The extracorporeal circuit was primed with a mixtur e of concentrated red cells, human albumin, and saline solution and wa s discarded at the end of the procedure. The average blood flow rate i n PE and/or PID circuits was 80 ml/min. During HBO, the girl breathed 100% oxygen at 2.5 atm for 90 min. Throughout the treatment, the patie nt was in good clinical, physical, and mental condition, but she was d ependent on blood purification procedures. She was referred to a liver transplant center and successfully transplanted. The etiology of live r failure has not been clarified.