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Case Reports
. 2018 Sep 30:2018:bcr2018225497.
doi: 10.1136/bcr-2018-225497.

Hypoxic hepatitis and furosemide

Ana Carina Pizzarossa  1 , Martín Rebella  1
Affiliations
Case Reports

Hypoxic hepatitis and furosemide

Ana Carina Pizzarossa et al. BMJ Case Rep. .

Abstract

Hypoxic hepatitis is a rather common complication of heart, circulatory or respiratory failure. We present the case of a patient with hypoxic hepatitis in the setting of heart failure and dehydration from furosemide as a reminder of an important clinical lesson. The pathogenesis of hypoxia (especially in the case of heart failure) is explained by a two-hit mechanism in which the liver at risk of hypoxic injury by passive hepatic congestion (right heart failure) is subsequently exposed to systemic hypoperfusion, which leads to a marked and transient elevation of aminotransferases. In the case presented, the use of furosemide (at least partially) promoted the second hit because it helped to generate hypotension and splanchnic hypovolaemia and favoured hepatic hypoxia.

Keywords: cardiovascular system; heart failure; hepatitis other.

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Conflict of interest statement

Competing interests: None declared.

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