CORONA VIRUS DISEASE-19-INDUCED ACUTE LIVER FAILURE LEADING TO SEVERE METABOLIC ACIDOSIS
CORONA VIRUS DISEASE-19-INDUCED ACUTE LIVER FAILURE LEADING TO SEVERE METABOLIC ACIDOSIS
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DOI：
10.1016/j.chest.2020.08.932
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发表时间：
2020-10-12
期刊：
影响因子：
9.6
通讯作者：
Jean LG
中科院分区：
文献类型：
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作者：
Sarkar S;Rapista N;Jean LG
DISCUSSION: Normal BP, evidence of good end organ perfusion, unchanged TTE findings and negative infectious work up ruled out cardiogenic and septic shock. Negative hepatitis viral screen, negative imaging tests and absence of hepatotoxic agents ruled out other causes of liver injury. NAC administration coincided with clinical improvement, although its role in the recovery process remained unclear. Severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] binds to angiotensin-converting enzyme 2 (ACE2) receptor to enter target cells. Studies have shown ACE2 receptors to have increased activity in cholangiocytes through which SARS-COV-2 can cause liver injury [2]. COVID-19 is known to cause multi-organ failure leading to acidosis. However, clinicians must be aware of lactic acidosis from purely COVID-19-induced acute liver failure as seen above.CONCLUSIONS: Acute onset lactic acidosis can be indicative of multiple processes which can be challenging to interpret in an urgent setting. Respiratory distress in COVID-19 patients is not always due to an acute lung process but may be related to metabolic acidosis induced tachypnea. Future studies looking at use of NAC in COVID-19-induced liver failure may be beneficial.
