Acute hepatic decompensation precipitated by pregnancy-related catabolic stress: a rare mimic of acute liver failure.

Abstract

BACKGROUND:

Abnormal liver function tests are common in pregnancy; however, liver failure is rare. Pregnancy is a catabolic state that can precipitate illness in patients with underlying metabolic disorders.

CASE:

A 19-year-old woman presented at 14 weeks of gestation with an alanine transaminase of 2,252 international units/L (less than 30), an international normalized ratio of 6.9 (0.9-1.2), and an ammonia of 58 micromole/L (11-51 micromole/L). No cause was identified on routine investigations including liver biopsy. Biochemical and clinical deterioration prompted investigation for a metabolic disorder. Urinary orotic acid was elevated, consistent with the urea cycle disorder type 1 citrullinemia. Appropriate management (arginine supplementation and dietary protein restriction) led to rapid improvement and later delivery of a healthy neonate.

CONCLUSION:

This is an unusual presentation that reminds us of the importance of considering metabolic disorders during the catabolic stress of pregnancy.

• Authors: Marie Sinclair, Shara Ket, Adam Testro, Paul J Gow, Peter W Angus
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 123 Issue 2 Pt 2 Suppl 2 Pg. 480-483 (Feb 2014) ISSN: 1873-233X [Electronic] United States
• PMID: 24413235 (Publication Type: Case Reports, Journal Article)

Topics

• Citrullinemia (complications, diagnosis)
• Diagnosis, Differential
• Female
• Humans
• Liver Failure, Acute (diagnosis)
• Pregnancy
• Pregnancy Complications (diagnosis)
• Young Adult