{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T03:15:49Z","timestamp":1784690149025,"version":"3.55.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"549","license":[{"start":{"date-parts":[[1971,7,1]],"date-time":"1971-07-01T00:00:00Z","timestamp":47174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1975,7,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>Acute fulminant hepatitis leads to complex biochemical and circulatory disturbances including coma. These can be predicted to some extent by knowledge of the functions of the normal liver cells. Ineffective haemostasis, coma, hypoglycaemia, electrolyte abnormalities, hypotension and renal circulatory failure are particularly important.<\/jats:p>\n               <jats:p>Management should be governed by the abnormalities found in the individual patient. Fluid overload and sedation must be avoided. More complex methods of temporary hepatic support such as exchange transfusion or perfusion of the isolated pig\u2019s liver should only be considered after simpler methods of correction have been attempted for a reasonable period of time and found wanting.<\/jats:p>\n               <jats:p>The prognosis of acute hepatocellular failure reaching the stage of deep coma is very poor, the mortality being about 80-90%.<\/jats:p>","DOI":"10.1136\/pgmj.47.549.493","type":"journal-article","created":{"date-parts":[[2008,12,29]],"date-time":"2008-12-29T20:27:15Z","timestamp":1230582435000},"page":"493-498","source":"Crossref","is-referenced-by-count":14,"title":["The management of acute hepatic failure"],"prefix":"10.1093","volume":"47","author":[{"given":"Sheila","family":"Sherlock","sequence":"first","affiliation":[{"name":"Departments of Medicine and Surgery, Royal Free Hospital , London W.C.1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S P","family":"Parbhoo","sequence":"additional","affiliation":[{"name":"Departments of Medicine and Surgery, Royal Free Hospital , London W.C.1"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[1975,7,1]]},"reference":[{"key":"ref_1","first-page":"64","article-title":"Treatment of hepatic coma by extra corporeal pig-liver perfusion","volume":"1","author":"ABOUNA, G.M.; KIRKLEY, J.R.; HULL, C.J.; ASHCROFT, T.; KERR, D.N.S.","year":"1969","unstructured":"ABOUNA, G.M., KIRKLEY, J.R., HULL, C.J., ASHCROFT, T. & KERR, D.N.S. (1969) Treatment of hepatic coma by extra corporeal pig-liver perfusion. Lancet, 1, 64.","journal-title":"Lancet"},{"key":"ref_2","article-title":"Longterm hepatic support by intermittent multispecies liver perfusions","volume":"291","author":"ABOUNA, G.M.; SERROU, B.; BOEHMIG, H.G.; AMEMIYA, H.; MARTINEAU, G.","year":"1970","unstructured":"ABOUNA, G.M., SERROU, B., BOEHMIG, H.G., AMEMIYA, H. & MARTINEAU, G. (1970) Longterm hepatic support by intermittent multispecies liver perfusions. Lancet, ii, 291.","journal-title":"Lancet"},{"key":"ref_3","article-title":"Immune complexes in hepatitis","volume":"983","author":"ALMEIDA, J.D.A.; WATERSON, A.P.","year":"1969","unstructured":"ALMEIDA, J.D.A. & WATERSON, A.P. (1969) Immune complexes in hepatitis. Lancet, ii, 983.","journal-title":"Lancet"},{"key":"ref_4","first-page":"651","article-title":"Etude critique des traitements actuels de l'insuffisance hepatique grave. Revue franfVaise d'Studes cliniques","volume":"12","author":"BENHAMOU, J.-P.; RUEFF, B.; SICOT, C.","year":"1968","unstructured":"BENHAMOU, J.-P., RUEFF, B. & SICOT, C. (1968) Etude critique des traitements actuels de l'insuffisance hepatique grave. Revue franfVaise d'Studes cliniques et biologiques, 12, 651.","journal-title":"et biologiques"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1056\/NEJM196603032740906","article-title":"Exchange transfusions in treatment of fulminant hepatitis","volume":"274","author":"BERGER, R.L.; LIVERSAGE, C.H.A.L.M.E.R.S.; C., T.; GRAHAM, J.H.; MCGOLDRICK, D.M.; STOHLMAN, F.","year":"1966","unstructured":"BERGER, R.L., LIVERSAGE, CHALMERS, T.C., GRAHAM, J.H., MCGOLDRICK, D.M. & STOHLMAN, F. (1966) Exchange transfusions in treatment of fulminant hepatitis. New England Journal of Medicine, 274, 497.","journal-title":"New England Journal of Medicine"},{"key":"ref_6","first-page":"935","article-title":"Renal blood flow in cirrhosis","volume":"276","author":"BRUNT, P.W.; VARMA, R.; HOURIGAN, K.; SHERLOCK, S.","year":"1970","unstructured":"BRUNT, P.W., VARMA, R., HOURIGAN, K. & SHERLOCK, S. (1970) Renal blood flow in cirrhosis. (In preparation.) BURNELL, J.M. & co-workers (1967) Acute hepatic coma, treated by cross-circulation or exchange transfusion. New England Journal of Medicine, 276, 935.","journal-title":"New England Journal of Medicine; Acute hepatic coma, treated by cross-circulation or exchange transfusion"},{"key":"ref_7","article-title":"Augmentation of albumin but not fibrinogen synthesis by corticosteroids in patients with hepatocellular disease","author":"CAIN, G.D.; MAYER, G.; JONES, E.A.","year":"1970","unstructured":"CAIN, G.D., MAYER, G. & JONES, E.A. (1970) Augmentation of albumin but not fibrinogen synthesis by corticosteroids in patients with hepatocellular disease. Journal of Clinical","journal-title":"Journal of Clinical"},{"key":"ref_8","article-title":"Jaundice and its relation to therapeutic agents","volume":"175","year":"1965","unstructured":"Investigations, 49, 2198. COOK, G.C. & SHERLOCK, S. (1965) Jaundice and its relation to therapeutic agents. Lancet, i, 175.","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1136\/gut.9.3.270","article-title":"Effect of corticosteroid therapy on bromsulphthalein excretion in active chronic hepatitis","volume":"9","author":"COOK, G.C.; VELASCO, M.; SHERLOCK, S.","year":"1968","unstructured":"COOK, G.C., VELASCO, M. & SHERLOCK, S. (1968) Effect of corticosteroid therapy on bromsulphthalein excretion in active chronic hepatitis. 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