Recurrent hepatic encephalopathy precipitated by urinary tract infection in patient with liver cirrhosis: a case report

Liver cirrhosis is a chronic liver injury marked by necro-inflammation and fibrogenesis. It is associated with several life-threatening complications. Hepatic encephalopathy remains to be one of the most debilitating complication of liver cirrhosis. The occurrence of hepatic encephalopathy may be directly related to endogenous worsening of liver function or occurs in the presence of specific precipitating factor. Infection such as urinary tract infection is a common precipitant of hepatic encephalopathy. We present a case of 66 year old female with recurrent hepatic encephalopathy in hepatitis B-related liver cirrhosis precipitated by urinary tract infection. Rapid and precise recognition of precipitating factor in hepatic encephalopathy is very substantial for implementation of preventive measures and optimal treatment plan in order to achieve better outcomes in liver cirrhosis patient.

Lidocaine Toxicity in a Patient with Liver Cirrhosis Underwent Transcatheter Aortic Valve Implantation

Background: Lidocaine has been commonly used in many clinical settings. Nonetheless, systemic toxicity can be life-threatening and careful attention to dosing, especially among patients with liver dysfunction is important to minimize the risk of toxicity. Objective: The diagnosis of lidocaine toxicity is usually clinical, while rare, but may prove fatal. Methods: Here we discuss 60 years-old man with advanced liver cirrhosis, developed lidocaine-induced cardiovascular and neurotoxicity. Results: Our case study demonstrates a successful treatment of cardiovascular and neurotoxicity with intravenous lipid emulsion in the context of systemic lidocaine toxicity in a liver cirrhosis patient who received lidocaine as a local anesthetic. Conclusions: A high index of suspicion should be maintained for severe toxicity even after subcutaneous administration and prompt intralipid administration may prove lifesaving.