2020 Volume 53 Issue 11 Pages 559-565
Here, we report two cases of hypoxic hepatitis (HH) involving chronic hemodialysis patients. Both patients were males in their 70s. Patient 1 was transferred to our hospital with a mild consciousness disorder and Cheyne-Stokes respiration. Patient 2 visited the emergency room on foot, complaining of pyrexia and shortness of breath, and was admitted to be treated for bronchopneumonia. Both patients exhibited abrupt marked increases in their transaminase levels without any specific symptoms. Their liver injuries had not been caused by viruses or drugs. Their serum transaminase levels spontaneously returned to baseline levels within two weeks. Both patients suffered atrial fibrillation, causing heart failure and sleep apnea syndrome (SAS). Finally, we diagnosed the patients with HH. HH, which is also referred to as “ischemic hepatitis” or “shock liver”, is characterized by a massive, rapid rise in serum transaminase levels, resulting from reduced oxygen delivery to the liver. The major causes of HH are septic shock, respiratory failure, and heart failure. In hemodialysis patients, atrial fibrillation and SAS are well known complications. Thus, we suggest that HH should be included in the differential diagnoses when an unexpected liver injury is found in a hemodialysis patient.
