Journal of hepatology
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Journal of hepatology · Oct 2007
Association between consumption of Herbalife nutritional supplements and acute hepatotoxicity.
Nutritional supplements are frequently considered to be harmless but indiscriminate use of unlabelled ingredients may lead to significant adverse reactions. ⋯ An association between intake of Herbalife products and acute hepatitis was identified in Israel. We call for prospective evaluation of Herbalife products for possible hepatotoxicity. Until then, caution should be exercised by consumers, especially among individuals suffering from underlying liver disease.
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Journal of hepatology · Oct 2007
Case ReportsHerbal does not mean innocuous: ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife products.
Herbal agents are popular and perceived as safe because they are supposedly 'natural'. We report 10 cases of toxic hepatitis implicating Herbalife products. ⋯ We present a case series of toxic hepatitis implicating Herbalife products. Liver toxicity may be severe. A more detailed declaration of components and pro-active role of regulatory agencies would be desirable.
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Journal of hepatology · Sep 2007
ReviewAdrenal insufficiency in liver disease - what is the evidence?
Recently, treatment with corticosteroids in the setting of septic shock and adrenal insufficiency has been shown to decrease mortality. In septic patients, a blunted response to adrenal stimulation identifies patients with a poorer prognosis who may benefit from corticosteroid supplementation. This condition has been termed relative adrenal insufficiency (RAI). ⋯ Although different definitions of RAI exist, the current literature suggests that RAI is common, being seen in 33% of acute liver failure patients and up to 65% of patients with chronic liver disease and sepsis. The finding that RAI can exist in the absence of sepsis and may be as high as 92% of patients undergoing liver transplantation using a steroid free protocol has led one group to propose the term hepatoadrenal syndrome. The purpose of this review is to summarise the existing evidence for adrenal insufficiency in liver disease, to examine the possibility that adrenal dysfunction in liver disease may have a separate pathogenesis to that observed in sepsis and to provide insight into the potential areas for further research into this condition.
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Journal of hepatology · Sep 2007
Comparative StudyComparison of terlipressin and noradrenalin on cerebral perfusion, intracranial pressure and cerebral extracellular concentrations of lactate and pyruvate in patients with acute liver failure in need of inotropic support.
Volume expansion and inotropic support with catecholamines are sometimes insufficient to ensure adequate blood pressure and cerebral perfusion in acute liver failure (ALF). The aim of this study was to determine if terlipressin increases cerebral perfusion, cerebral concentration of lactate and intracranial pressure (ICP), and to compare the effect with that of noradrenalin (NA). ⋯ This study shows that terlipressin increases CPP and cerebral perfusion with little influence upon ICP and cerebral [lactate]ec in ALF patients. These findings indicate that terlipressin may be valuable, as an additive treatment to NA infusion to secure brain viability.