A case of fulminant hepatitis cured with the glucagon-insulin treatment

A 17-year-old male patient with fulminant hepatitis who could be cured with the glucagon-insulin (G-I) treatment is reported. The patient was severely jaundiced (total scrum bilirubin 12.6mg/dl), his serum alanine aminotransferase 828 units, blood ammonia 101μg/dl and both HBs antigen and HBs antibo...

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Published inKanzo Vol. 21; no. 10; pp. 1352 - 1357
Main Authors HOSOKAWA, Yukio, SUGA, Mitsuo, YOKOYAMA, Yoko, KINOSHITA, Hiroshi, ANZAI, Tetsuro, FUJISAWA, Yasunori, FUJISHIMA, Akira, FUJITA, Hideo, SAITO, Michiko
Format Journal Article
LanguageJapanese
Published The Japan Society of Hepatology 1980
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AFP
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Abstract A 17-year-old male patient with fulminant hepatitis who could be cured with the glucagon-insulin (G-I) treatment is reported. The patient was severely jaundiced (total scrum bilirubin 12.6mg/dl), his serum alanine aminotransferase 828 units, blood ammonia 101μg/dl and both HBs antigen and HBs antibody were simultaneously detected with the radioimmunoassay. Intensive parenteral administrations of prednisolone and l-DOPA, combined with rectal applications of lactulose, proved ineffective in preventing from his Grade III (Adams and Foley) hepatic encephalopathy with asterexis. The G-I treatment was therefore started, which resulted in awakening from coma with a decrease of blood ammonia. During the clinical course, serum AFP level was as high as 782ng/ml, and the liver biopsy specimen obtained after recovery showed cirrhosis of the liver. The mechanism by which the G-I treatment favours the fulminant hepatic disorder was discussed.
AbstractList A 17-year-old male patient with fulminant hepatitis who could be cured with the glucagon-insulin (G-I) treatment is reported. The patient was severely jaundiced (total scrum bilirubin 12.6mg/dl), his serum alanine aminotransferase 828 units, blood ammonia 101μg/dl and both HBs antigen and HBs antibody were simultaneously detected with the radioimmunoassay. Intensive parenteral administrations of prednisolone and l-DOPA, combined with rectal applications of lactulose, proved ineffective in preventing from his Grade III (Adams and Foley) hepatic encephalopathy with asterexis. The G-I treatment was therefore started, which resulted in awakening from coma with a decrease of blood ammonia. During the clinical course, serum AFP level was as high as 782ng/ml, and the liver biopsy specimen obtained after recovery showed cirrhosis of the liver. The mechanism by which the G-I treatment favours the fulminant hepatic disorder was discussed.
Author KINOSHITA, Hiroshi
ANZAI, Tetsuro
SUGA, Mitsuo
SAITO, Michiko
YOKOYAMA, Yoko
FUJISHIMA, Akira
FUJISAWA, Yasunori
HOSOKAWA, Yukio
FUJITA, Hideo
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  fullname: YOKOYAMA, Yoko
  organization: Department of Internal Medicine, Muroran City General Hospital
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  fullname: KINOSHITA, Hiroshi
  organization: Department of Internal Medicine, Muroran City General Hospital
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  fullname: ANZAI, Tetsuro
  organization: Department of Internal Medicine, Muroran City General Hospital
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  fullname: FUJISAWA, Yasunori
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  fullname: FUJISHIMA, Akira
  organization: Department of Internal Medicine (Section 1) Sapporo Medical College
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  fullname: FUJITA, Hideo
  organization: Department of Internal Medicine (Section 1) Sapporo Medical College
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  fullname: SAITO, Michiko
  organization: Department of Internal Medicine (Section 1) Sapporo Medical College
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References 12) 沖田極他:肝疾患治療薬の作用に関する基礎的研究(2).重症肝炎の治療を目的としたglucagon-insulin療法の基礎的研究.肝臓,19: 848, 1978.
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5) 安斎哲郎:肝性脳症について.市立室蘭医誌,4: 1, 1979.
4) Bucher, N.L.R. & Swaffeld, M.N.: Regulation of hepatic regeneration in rats by synergistic action of insulin and glucagon. Proc. Nat, Acad. Sci. USA, 72: 1157, 1975.
11) Price, J.B.: Glucagon as the portal factor modifying hepatic regeneration. Surgery, 72: 74, 1972.
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15) Murray-Lyon, I.M.: Prognostic value of serum alpha-fetoprotein in fulminant hepatic failure including Patients treated by charcoal haemoperfusion. Gut, 17: 576, 1976.
2) Trey, C.: The fulminant hepatic failure surveillance study. Brief review of thc effects of presumed etiology and age of survival. Canad. Med. Ass. J., 106: 525, 1972.
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13) 沖田極他:肝疾患治療薬の作用に関する基礎的研究(3). glucagon-insulin療法による急性,慢性肝不全の治療.肝臓,19: 854,1978.
14) 菅充生他:高AFP値を示した亜急性肝壊死の1例.日内会誌,65: 183, 1976.
1) 高橋善弥太他:劇症肝炎の全国集計,第9回犬山シンポジウム記録集,中外医学社,東京,1977, p.3.
3) Adams, R.D. & Foley, J.M.: The neurological disorder associated with liver disease. Res. Publ. Ass. Res. Nerv. Ment, Dis., 32: 198, 1953.
16) Karvountzis, G.G. & Redeker, A.G.: Relation of alpha-fetoprotein in acute hepatitis to severity and prognosis. Ann. Int. Med., 80: 156, 1974.
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Title A case of fulminant hepatitis cured with the glucagon-insulin treatment
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