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CASE REPORT
Year : 2021  |  Volume : 10  |  Issue : 2  |  Page : 138-139

Elevated liver enzymes in association with vasopressin use in a neonate


Department of Pediatrics, School of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA

Date of Submission11-Aug-2020
Date of Decision30-Nov-2020
Date of Acceptance10-Dec-2020
Date of Web Publication15-May-2021

Correspondence Address:
Shabih Manzar
Department of Pediatrics, School of Medicine, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71103
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.jcn_128_20

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  Abstract 


Vasopressin has been used in neonates for refractory hypotension. Elevation in liver enzymes due to mesenteric mucosal hypoperfusion has been associated with the use of vasopressin in adults. We present a case of a neonate that develop elevated liver enzymes in association with vasopressin use and migration of umbilical venous catheter.

Keywords: Hypotension, liver enzymes, neonates, vasopressin


How to cite this article:
Manzar S. Elevated liver enzymes in association with vasopressin use in a neonate. J Clin Neonatol 2021;10:138-9

How to cite this URL:
Manzar S. Elevated liver enzymes in association with vasopressin use in a neonate. J Clin Neonatol [serial online] 2021 [cited 2022 Dec 2];10:138-9. Available from: https://www.jcnonweb.com/text.asp?2021/10/2/138/316168



Vasopressin has been used in neonates for refractory hypotension.[1] Elevation in liver enzymes due to mesenteric mucosal hypoperfusion has been associated with the use of vasopressin in adults.[2],[3] We present a case of a neonate that develop elevated liver enzymes in association with vasopressin use and migration of umbilical venous catheter (UVC).

A male infant on day 10 of life developed Gram-negative sepsis and refractory hypotension. Vasopressin drip (0.04 units/kg/h) was added to dopamine and epinephrine drips infused through an UVC. Vasopressin was discontinued on day 14 of life (total 4 days of continuous drip) as infant's blood pressure improved. [Table 1] depicts the serial serum liver enzyme levels.
Table 1: Serial liver function tests (Bilirubin and enzymes)

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We postulated that a combination of UVC migration and vasopressin infusion has resulted in the transient elevation of liver enzymes. UVCs are commonly placed in neonates for intravenous access. The preferred location of the tip of the UVC is the cephalad portion of the inferior vena cava or at the inferior vena caval-right atrial junction.[4],[5] We noticed the caudal migration of UVC. [Figure 1] shows the comparison on the position of UVC. In addition to anasarca noted on second X-ray, the UVC is noted to have migrated caudally, represented by asterisk. Liver ultrasound [Figure 2] showed UVC in the right hepatic vein with normal Doppler study.
Figure 1: Chest X-rays obtained on day 3 and 12. Note the change in the position of umbilical venous catheter on the X-ray. The star sign on the illustration corresponds to the position of umbilical venous catheter in two X-rays. On the right side-illustration shows the normal course of umbilical venous catheter

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Figure 2: Liver ultrasound: (a) Transverse view showing umbilical venous catheter near the right hepatic vein. (b) Normal Doppler-transverse view. (c) Sagittal view-showing normal hepatic structure and normal inferior vena cava

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Hepatic injuries have been reported in associated with UVC.[6],[7] Despite of abnormal liver function tests, we did not note any structural damage to the liver on US with preserved circulation. Vasopressin is a potent vasoconstrictor that may lead to hypoxic liver injury resulting in elevated enzymes. We postulated that a combination of UVC migration and vasopressin has resulted in transient elevation in the liver enzymes in this neonate.

In conclusion, UVC position and liver enzymes should be monitored closely when vasopressin is used in neonates.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ikegami H, Funato M, Tamai H, Wada H, Nabetani M, Nishihara M. Low-dose vasopressin infusion therapy for refractory hypotension in ELBW infants. Pediatr Int 2010;52:368-73.  Back to cited text no. 1
    
2.
Dunser MW, Mayr AJ, Ulmer H, Ritsch N, Knotzer H, Pajk W, et al. The effects of vasopressin on systemic hemodynamics in catecholamine-resistant septic and postcardiotomy shock: A retrospective analysis. Anesth Analg 2001;93:7-13.  Back to cited text no. 2
    
3.
Dunser MW, Mayr AJ, Ulmer H, Knotzer H, Sumann G, Pajk W, et al. Arginine vasopressin in advanced vasodilatory shock: A prospective, randomized, controlled study. Circulation 2003;107: 2313-19.  Back to cited text no. 3
    
4.
Oestreich AE. Umbilical vein catheterization—appropriate and inappropriate placement. Pediatr Radiol 2010;40:1941-9.  Back to cited text no. 4
    
5.
Schlesinger AE, Braverman RM, DiPietro MA. Pictorial essay. Neonates and umbilical venous catheters: Normal appearance, anomalous positions, complications, and potential aid to diagnosis. AJR Am J Roentgenol 2003;180:1147-53.  Back to cited text no. 5
    
6.
Lim-Dunham JE, Vade A, Capitano HN, Muraskas J. Characteristic sonographic findings of hepatic erosion by umbilical vein catheters. J Ultrasound Med 2007;26:661-6.  Back to cited text no. 6
    
7.
Mahajan V, Rahman A, Tarawneh A, Sant'anna GM. Liver fluid collection in neonates and its association with the use of a specific umbilical vein catheter: Report of five cases. Paediatr Child Health 2011;16:13-5.  Back to cited text no. 7
    


    Figures

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    Tables

  [Table 1]



 

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