{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T12:45:25Z","timestamp":1772801125264,"version":"3.50.1"},"reference-count":17,"publisher":"BMJ","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Gut"],"published-print":{"date-parts":[[1977,12]]},"abstract":"<jats:p>Studies on the incidence and pathophysiology of hypotension in fulminant hepatic failure showed that 82 out of 94 patients developed arterial hypotension with a systolic blood pressure of less than 80 mmHg. Such episodes accounted for 16% of the total time spent in grade IV coma. Factors such as haemorrhage, cardiac or respiratory abnormalities, extracorporeal perfusion, or hypotension which occurred during the terminal stages of the illness, could be implicated for only 40% of this time, leaving 60% as unexplained. Further investigation of these unexplained factors showed that peripheral vasodilatation rather than primary heart failure was responsible, and in all but three patients construction of ventricular function curves showed a normal ventricular response to volume expansion with a corresponding increase in blood pressure. A small, but significant, slowing of the heart rate occurred during these periods of unexplained hypotension. This, together with the association that was found between the occurrence of hypotension and cerebral oedema with coning, suggests that central vasomotor depression may be important in its pathogenesis.<\/jats:p>","DOI":"10.1136\/gut.18.12.1021","type":"journal-article","created":{"date-parts":[[2007,9,18]],"date-time":"2007-09-18T17:41:31Z","timestamp":1190137291000},"page":"1021-1026","source":"Crossref","is-referenced-by-count":80,"title":["Pathophysiology of hypotension in patients with fulminant hepatic failure."],"prefix":"10.1136","volume":"18","author":[{"given":"P N","family":"Trewby","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Williams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1977,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1161\/01.CIR.35.2.327","article-title":"Cardiovascular function in shock: responses to volume loading and isoproterenal infusion","volume":"35","author":"Carey, J.S.; Brown, R.S.; Mohr, P.A.; Monson, D.O.; Yao, S.T.; Shoemaker, W.C.","year":"1967","unstructured":"Carey, J. S., Brown, R. S., Mohr, P. A., Monson, D. O., Yao, S. T., and Shoemaker, W. C. (1967). Cardiovascular function in shock: responses to volume loading and isoproterenal infusion. Circulation, 35, 327-338.","journal-title":"Circulation"},{"key":"ref_2","first-page":"29","article-title":"An evaluation of the measurement of the cardiac output and the so-called pulmonary blood volume by the dye-dilution method","volume":"41","author":"Doyle, J.T.; Wilson, J.S.; Lepine, C.; Warren, J.V.","year":"1953","unstructured":"Doyle, J. T., Wilson, J. S., Lepine, C., and Warren, J. V. (1953). An evaluation of the measurement of the cardiac output and the so-called pulmonary blood volume by the dye-dilution method. 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Endotoxin-induced liver necrosis and intravascular coagulation in rats enhanced by portacaval collatera circulation. Gut, 16,429-436."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/00005792-196903000-00003","article-title":"Acute hepatic necrosis with stupor or coma. An analysis of 31 patients","volume":"48","author":"Ritt, D.J.; Whelan, G.; Werner, D.J.; Eigenbrodt, E.H.; Schenker, S.; Combes, B.","year":"1969","unstructured":"Ritt, D. J., Whelan, G., Werner, D. J., Eigenbrodt, E. H., Schenker, S., and Combes, B. (1969). Acute hepatic necrosis with stupor or coma. An analysis of 31 patients. Medicine (Balt.), 48, 151-172.","journal-title":"Medicine (Balt.)"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1136\/gut.14.10.805","article-title":"Acute hepatic necrosis and fulminant hepatic failure","volume":"14","author":"Rueff, B.; Benhamou, J.-P.","year":"1973","unstructured":"Rueff, B., and Benhamou, J-P. (1973). Acute hepatic necrosis and fulminant hepatic failure. Gut, 14, 805-815.","journal-title":"Gut"},{"key":"ref_11","first-page":"1","article-title":"Treatment of fulminant hepatic failure by haemodialysis using a polyacrylonitrile membrane","volume":"2","author":"Silk, D.B.A.; Hanid, M.A.; Trewby, P.N.; Davies, M.; Chase, R.A.; Langley, P.G.; Mellon, P.J.; Wheeler, P.G.; Williams, R.","year":"1977","unstructured":"Silk, D. B. A., Hanid, M. A., Trewby, P. N., Davies, M., Chase, R. A., Langley, P. G., Mellon, P. J., Wheeler, P. G., and Williams, R. (1977). Treatment of fulminant hepatic failure by haemodialysis using a polyacrylonitrile membrane. Lancet 2, 1-3.","journal-title":"Lancet"},{"key":"ref_12","first-page":"466","article-title":"Intrapulmonary vascular shunts in fulminant hepatic failure","volume":"14","author":"Trewby, P.N.; Williams, R.; Williams, A.; Reid, L.","year":"1976","unstructured":"Trewby, P. N., Williams, R., Williams, A., and Reid, L. (1976). Intrapulmonary vascular shunts in fulminant hepatic failure. Digestion, 14, 466 (Abstract.)","journal-title":"Digestion"},{"key":"ref_13","article-title":"The effects of cerebral oedema and arterial hypotension on cerebral blood flow in an animal model of hepatic failure","author":"Trewby, P.N.; Hanid, A.; Mackenzie, R.L.; Mellon, P.J.; Williams, R.","year":"1978","unstructured":"Trewby, P. N., Hanid, A., Mackenzie, R. L., Mellon, P. J., and Williams, R. (1978). The effects of cerebral oedema and arterial hypotension on cerebral blood flow in an animal model of hepatic failure. (Submitted for publication.)"},{"key":"ref_14","first-page":"305","article-title":"The role of the false neurotransmitter octopamine in the hypotension of fulminant hepatic failure","volume":"52","author":"Trewby, P.N.; Chase, R.A.; Davis, M.; Williams, R.","year":"1977","unstructured":"Trewby, P. N., Chase, R. A., Davis, M., and Williams, R. (1977). 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Eyre and Spottiswoode: London.","edition":"2nd rev. edn"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gut.18.12.1021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T20:12:57Z","timestamp":1757275977000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gut.18.12.1021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1977,12]]},"references-count":17,"journal-issue":{"issue":"12","published-online":{"date-parts":[[1977,12,1]]},"published-print":{"date-parts":[[1977,12]]}},"alternative-id":["10.1136\/gut.18.12.1021"],"URL":"https:\/\/doi.org\/10.1136\/gut.18.12.1021","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[1977,12]]}}}