Prophylactic phenytoin does not improve cerebral edema or survival in acute liver failure--a controlled clinical trial

Journal of Hepatology
Vikram BhatiaSubrat Kumar Acharya

Abstract

Seizure activity in patients with acute liver failure (ALF) may increase cerebral oxygen requirements and worsen cerebral edema. Recently, prophylactic phenytoin has been recommended to suppress sub-clinical seizure activity evident on electroencephalographic monitoring. To determine the clinical utility of prophylactic phenytoin therapy in patients with ALF. Forty two patients with ALF were randomized. Twenty two patients were given prophylactic phenytoin and 22 patients acted as controls. The baseline clinical and biochemical features were similar in the two groups and patients with > or =2 poor prognostic variables were equally represented. Sixteen patients in the phenytoin group, and 15 in the control group developed cerebral edema (P=0.38). Mechanical ventilation was required in 10 and 12 patients in the phenytoin and control groups, respectively, (P=0.77). Seizures occurred in 5 (22.7%) control patients and 5 (25%) phenytoin treated patients (P=0.86). Fourteen (70%) patients randomized to phenytoin and 15 (68.2%) control patients died (P=0.89). Seizure was common in patients with ALF. Prophylactic use of phenytoin did not prevent cerebral edema, seizures or need for mechanical ventilation, and did not improve survival.

References

May 1, 1986·Seminars in Liver Disease·R J Ede, R W Williams
Mar 1, 1986·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·A E GimsonR Williams
Jul 1, 1986·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·J BernuauJ P Benhamou
Feb 1, 1994·Journal of Medical Virology·S K NandaS K Panda
Oct 1, 1993·Anesthesiology·M Csete, J B Sullivan
Jun 1, 1993·Journal of Neurosurgery·T O Grøndahl, I A Langmoen
Apr 1, 1996·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·F V SchiødtN Tygstrup
Jun 1, 1996·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·S K AcharyaB N Tandon
Aug 29, 2000·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·A J EllisR Williams
Aug 29, 2000·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·A T Blei

❮ Previous
Next ❯

Citations

Apr 25, 2012·Current Gastroenterology Reports·Daniel D'AgostinoGustavo Boldrini
Nov 6, 2004·Current Treatment Options in Gastroenterology·J Eileen Hay
Dec 3, 2010·Neurocritical Care·Jennifer A Frontera, Thomas Kalb
Aug 12, 2009·Hepatology International·Vikram BhatiaAnoop Saraya
Oct 29, 2013·Best Practice & Research. Clinical Gastroenterology·Tony Whitehouse, Julia Wendon
Dec 15, 2011·American Journal of Respiratory and Critical Care Medicine·Andrew M Naidech
May 5, 2012·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Ramesh Kumar, Vikram Bhatia
Jan 5, 2008·Neurological Research·Javier Vaquero, Roger F Butterworth
May 9, 2014·Current Treatment Options in Neurology·Jennifer A Frontera
Jul 9, 2013·Critical Care Clinics·Saumya JayakumarConstantine J Karvellas
Nov 10, 2011·Neurochemistry International·Debbie L Shawcross, Julia A Wendon
Sep 7, 2011·Gastroenterology Clinics of North America·Vinay Sundaram, Obaid S Shaikh
Feb 3, 2009·Clinics in Chest Medicine·Michael L SchilskySukru Emre
Jun 24, 2008·Disease-a-month : DM·Anne M Larson
Feb 5, 2008·Critical Care Clinics·Andres T Blei
Feb 24, 2007·Journal of Hepatology·Andres T Blei
Mar 22, 2005·Journal of Hepatology·Rajiv Jalan
Oct 26, 2005·Journal of Hepatology·Javier VaqueroRoger F Butterworth
Jun 5, 2015·Journal of Clinical and Experimental Hepatology· Shalimar, Subrat K Acharya
Jun 18, 2016·Current Treatment Options in Neurology·José M FerroPatrícia Santos
Jun 25, 2016·Critical Care Clinics·Prem A Kandiah, Gagan Kumar
Oct 16, 2016·Journal of Pediatric Gastroenterology and Nutrition·Riad LutfiGirish Subbarao
Oct 18, 2008·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Vikram BhatiaSubrat Kumar Acharya
Sep 29, 2007·Critical Care Medicine·R Todd StravitzUNKNOWN Acute Liver Failure Study Group
Oct 13, 2006·International Anesthesiology Clinics·William T Merritt
Apr 21, 2005·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Julie PolsonUNKNOWN American Association for the Study of Liver Disease
Aug 5, 2009·Nature Reviews. Gastroenterology & Hepatology·R Todd Stravitz, David J Kramer
Apr 9, 2010·The Korean Journal of Hepatology·Young Suk Lim
Mar 3, 2010·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Ramesh KumarSubrat K Acharya
Jan 14, 2012·Journal of Viral Hepatitis·A SrivastavaU Poddar
Jul 20, 2012·Continuum : Lifelong Learning in Neurology·Jennifer A Frontera
May 12, 2019·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Alexandra S ReynoldsNeha S Dangayach
Feb 6, 2016·Current Opinion in Critical Care·Prem A KandiahRam M Subramanian
Feb 28, 2007·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Lars E Schmidt, Fin Stolze Larsen
Aug 10, 2017·Neurocritical Care·Christopher R NeweyStephen Hantus
Jan 1, 2018·Current Pediatrics Reports·Heli Bhatt, Girish S Rao
Mar 11, 2005·Journal of Clinical Gastroenterology·Javier Vaquero, Andres T Blei
Sep 17, 2019·Anaesthesia Critical Care & Pain Medicine·E Weiss, L Velly
Nov 12, 2018·The American Journal of Emergency Medicine·Tim MontriefBrit Long

❮ Previous
Next ❯

Related Concepts

Related Feeds

Atrophic Gastritis

Atrophic Gastritis is a process where gastric glandular cells are lost and replaced with firbous tissues, as a result of chronic inflammation. Learn more about Atrophic Gastritis here.

Related Papers

Hepatology : Official Journal of the American Association for the Study of Liver Diseases
A EllisR Williams
Hepatology : Official Journal of the American Association for the Study of Liver Diseases
Nicholas MurphyJulia Wendon
Hepatology : Official Journal of the American Association for the Study of Liver Diseases
N RolandoR Williams
© 2022 Meta ULC. All rights reserved