South Dakota medicine : the journal of the South Dakota State Medical Association
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There are so far only a few reported cases of acute fulminant hepatic failure resulting from acute cardiomyopathy. This is a rare occurrence, especially in patients that do not exhibit any signs and symptoms of acute cardiac decompensation. We report a case of fulminant liver failure with nondiagnostic work up for the common causes of liver failure. ⋯ Echocardiogram revealed dilated left atrium and ventricle, severe mitral regurgitation, severe tricuspid regurgitation, grade 4 diastolic dysfunction, diffuse hypokinesis of left ventricle, and severely and newly reduced systolic function with an ejection fraction of 10 percent (decreased from 25 percent on last ECHO 18 months prior). Liver biopsy demonstrated marked centrilobular hepatocyte necrosis and dropout accompanied by congestion, some areas of bridging necrosis and focal confluent necrosis which was suggestive of severe congestive hepatopathy. With initiation of heart failure medications, liver function improved significantly.
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A patient's transition from hospitalization to discharge may represent an additional opportunity for antibiotic stewardship. ⋯ Our results align with the only previously published study of oral antibiotics prescribed at hospital discharge, both in the duration of inpatient and outpatient therapy and in the fact that about 60 percent of the treatment duration occurred after discharge. However, the median total antibiotic duration of 10 days is longer than that recommended by national and institutional guidelines for some of the most common infections in hospitalized patients.