Face2News/Health Reporter/Chandigarh
Harshita Verma, 14-year-old girl child, CR no: 202301586195, was admitted in Paediatric Gastroenterology & Hepatology ward, PGIMER Chandigarh, from 17/2/23 to 28/2/23with a diagnosis of Acute liver failure due to acute viral hepatitis (HAV), advanced (stage III) hepatic encephalopathy (abnormal brain function) and coagulopathy (increased bleeding tendency).
She was advised to undergo a liver transplantation in a hospital outside. The parents chose to bring her to PGIMER. She also developed hepatorenal syndrome (renal failure) and shock (low BP) during hospital stay. She was appropriately managed by the team of Paediatric Gastroenterology & Hepatology. which was managed with albumin and nor-adrenaline infusions. Peak ammonia level was 286 millimol/dl. The girl recovered fully with medical management and good supportive care and walked out of hospital after 11 days and continues to remain well at home.
Rutakshi, 11-year-old girl child, CR no: 202301045194,was admitted at PGE ward, PGIMER Chandigarh, from 5/1/23 to 3/3/23 with a diagnosis of Acute on Chronic Liver Failure. She had coagulopathy and hemolysis and had been advised to undergo a liver transplantation in a private hospital outside, considering the grave nature of her disease.
The parents however, chose to bring her to PGIMER, to the Division of Paediatric Gastroenterology & Hepatology. Here she was diagnosed to have Wilson Disease and was listed for Liver transplantation as her PELD score was high and her chances for survival without transplantation were low. However, simultaneously she was started on Plasma exchanges, D Penicillamine and other supportive measuresDue to unavailability of live donor, she was then listed for deceased donor liver transplant (DDLT).
However, with meticulous attention to details and meticulous management of her complex issues, the patients’ liver parameters stabilized and the frequency of weekly PLEX sessions reduced. She was discharged after nearly 2 months in a much improved status with an improvement in all parameters. She is currently under regular follow-up and her liver function tests and coagulopathy is showing steady improvement.
Mahira, 6.5-year-old girl child, CR no: 202301404526, was admitted at PGE ward, PGIMER Chandigarh, from 5/2/23 to 3/3/23 with a diagnosis of Acute Liver Failure due to acute viral hepatitis (HAV) with stage IV (very advanced) hepatic encephalopathy. She was also advised liver transplantation outside but her parents chose to come to PGIMER. Patient had repeated posturing due to increased pressure in her brain and required intubation and mechanical ventilation for 5 days.
Raised intracranial pressure was medically managed. Patient was kept on N-acetyl cysteine infusion along with measures to control hyperammonemia. Patient’s liver parameters started improving within 24 hours. She also developed shock during hospital stay for which inotropic support was given for 48 hours. She had several other complications because of her basic disease which were successfully managed by the dedicated efforts of the team of Paediatric Gastroenterology & Hepatology. She was discharged after a month of hospital stay. She is currently under regular follow-up; her coagulation profile is normal; she is out of danger.
The above cases are an example of the exemplary dedication, team work, meticulous and scientific approach of the Division of Paediatric Gastroenterology & Hepatology which saved the lives of three very sick children who had been almost subjected to liver transplantation in outside hospitals. The efforts were highly appreciated by all three families, especially since Liver Transplantation is not only a difficult and very costly procedure but is also associated with a poorer quality of life, increased cost after transplantation and a lifelong risk of complications.