Albumin dialysis with the M.A.R.S. (Molecular Absorbent Recirculating System) for a patient with acute liver failure due to paracetamol intoxication: A case-report

A 49 year-old woman was admitted 3 days after intake of 15 g of paracetamol. At admission the concentration of paracetamol in the blood was within therapeutic limits, but she had severe dearranged liver function tests. Serum-ALAT was almost 200 ukat/l, serum-creatinine above 400 umol/l and PK 4,1 INR.

The patient was in a critical condition, i. e. she was unconscious with increased intracranial pressure, accompanied by seizures, anuria, acidocis and severe coagulopathy. In addition, adequate bloodsugar levels could not be maintained, inspite of 20 % glucosinfusion. Body temperature was decreasing. Taken together, all signs of a life threatening acute liver failure was present. Therefore the patient was put on the urgent call list for liver transplantation.

In the mean time, albumin dialysis with the M.A.R.S. treatment was started in combination with ordinary hemodialysis (Gambro AK100). This treatment was performed continuously for 3 days. After the first day of treatment the intracranial pressure declined and the patient’s blood pressure, temperature and cerebral condition were stabilized.

On the third day of treatment the patient’s INR declined spontaneously, liver function tests were considerbly improved and the intracraniel pressure was normalized. The M.A.R.S. treatment was discontinued. CVVHD (continuous veno-venous hemodialysis) was continued for an other day, until renal function was restored.

The patient recovered completly and was dismissed 3 weeks after admission with normal liver function tests, except for sligtly elevated bilirubin level. There were no signs of cerebral damage present. No adverse event occured during the M.A.R.S. treatment.

Conclusion: M.A.R.S. albumin dialysis appears to be a safe and effective treatment to bridge patients with severe acute liver failure after paracetamol intoxication until their own liver recovers or, if necessary, to liver transplantation.