Clinical and experimental studies on impaired glucose regulation in patients with two clinical forms of fulminant hepatitis.

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To evaluate the frequency of hypo- or hyperglycemia, glucose regulatory mechanism and therapeutic problems in fulminant hepatitis (FH), we have examined the serial changes of plasma glucose levels in 47 patients with two clinical forms; acute (FHA) and subacute (FHS) forms of FH. The occurrence of severe hypoglycemia in fatal patients with FHA (40%) was significantly higher than that of FHS (4.2%). Furthermore, hypoglycemia of FHA was detected at an early stage, but that of FHS was observed at a terminal stage. On the other hand, none of the hypoglycemia found in survived cases of FH.<BR>Difference in frequency and period of hypoglycemia between FHA and FHS suggests that hypoglycemia may occur due to rapid and massive hepatic necrosis. In fact, the plasma c-AMP and glucose responses to exogenous glucagon was significantly decreased in FH with fatal outcome. Experimentally, glucose disposal rates evaluated by IVGTT and ITT was normal in AHF rats. It is conceivable that therapeutic administration of glucose is fundamental and most important in medical management, especially at an early stage of FH.
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