Improvement by Acetylcysteine of Hemodynamics and Oxygen Transport in Fulminant Hepatic Failure

• Published in: The New England journal of medicine Vol. 324; no. 26; pp. 1852 - 1857
• Main Authors: Harrison, Phillip M, Wendon, Julia A, Gimson, Alexander E.S, Alexander, Graeme J.M, Williams, Roger
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 27.06.1991
• Subjects: Acetaminophen; Acetaminophen - poisoning; Acetylcysteine; Acetylcysteine - administration & dosage; Acetylcysteine - pharmacology; Acetylcysteine - therapeutic use; Adolescent; Adult; Analgesics; Biological and medical sciences; Biological Transport - drug effects; Blood pressure; Body weight; Chemical and Drug Induced Liver Injury - etiology; Circulatory system; Dextrose; Digestive system; Drug Overdose; Endothelium; Female; Glutathione; Heart diseases; Hemodynamics; Hemodynamics - drug effects; Hepatic Encephalopathy - drug therapy; Hepatic Encephalopathy - physiopathology; Hepatitis; Hepatitis C - complications; Hepatitis, Alcoholic - complications; Humans; Hypotheses; Hypoxia; Intravenous administration; Laboratories; Liver; Liver failure; Male; Medical prognosis; Medical sciences; Metabolism; Middle Aged; Neutrophils; Overdose; Oxygen; Oxygen - metabolism; Oxygen consumption; Oxygen Consumption - drug effects; Pathogenesis; Pharmacology. Drug treatments; Pulmonary arteries; Survival; Veins & arteries; Ventilators; Human; Chemotherapy; Liver failure; Treatment; Toxicity; Digestive diseases; Hepatic disease; Fulminant
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM199106273242604

IN normal subjects tissue oxygen consumption is maintained at around 110 ml per minute per square meter of body-surface area, and changes in oxygen delivery are counterbalanced by reciprocal changes in the proportion of oxygen extracted. In critically ill patients tissue oxygen consumption becomes dependent on oxygen delivery because the ability of tissues to extract oxygen is reduced, 1 2 3 4 5 6 so that even though oxygen delivery usually increases, it may be inadequate for tissue requirements. 7 Then anaerobic metabolism supervenes, leading to the accumulation of lactic acid. The pathogenesis of impaired tissue oxygen extraction is poorly understood, but it may be the consequence . . .