Zinc as a Rescue Therapy for Acute Liver Failure: Report of 3 Cases

Abstract

Introduction: Acute liver failure as a rare but potentially life threatening condition occurs most often in individuals without any history of preexisting chronic liver disease. This is report of salvage therapy of 3 cases of acute liver failure by Zinc sulfate as a rescue option. Cases & method: In a 4 months period we had 3 cases of acute liver failure referred to our center. 2 of them were female and one was male. One of them presented with hepatic encephalopathy (a 16 y old girl) and the others attended by complain of icterus and disturbed liver function tests (a 24 y old man and 28 y old woman). There was no history of any drug usage and serologic profile of viral hepatitis was also negative. The average MELD score was 22 and we deferred liver biopsy due to profound coagulopathy (INR > 2.2 on average). Salvage therapy with Zinc sulfate (50mg TDS) in concordance with conservative management began while waiting for results of autoimmune hepatitis serology. Their condition gradually got improve and by preparation of complementary serologic results consistent with AIH, prednisolone added to this drug regimen. Results:The condition of all 3 cases improved and the function of their livers retrieved. Their coagulopathy got better, jaundice relieved and they regained their consciousness. After average 8 day of admission, they discharged and followed in our outpatient clinic. In one and 6 months follow up, their MELD score declined to 8.3 (6, 8 and 11 respectively) and therapy with prednisolone and Azathioprine continued. Their follow up and close observation have going on up to 1 year thereafter. Conclusion:Zinc sulfate could be a potential treatment option as rescue therapy in acute liver failure and acts as a bridge to definite therapy (if any at all). We recommend this therapeutic approach to be further verify in future investigations.