ACUTE LIVER FAILURE

Question 1

Criteria

Answer 1

Acute Insult to Liver + Coagulopathy (INR > 1.5) + Encephalopathy (<8 weeks). No h/o cirrhosis

Question 2

Etiology

Answer 2

Acetaminophen
Anti-TB Drugs
Anti-AED Drugs
MDMA
Amanita Phalloids
HAV
HBV
HCV
Wilson’s
Budd Chiari
Ischemic Hepatitis

Question 3

Investigations

Answer 3

CBC
Lytes
Extended Lytes, Mg
LFTs
Albumin
INR / aPTT
Ammonia
Fibrinogen
Urea
Creatinine
Lactate

Acetaminophen Level
HBV
HCV
HSV

Ascitic Fluid Analysis: Cell count with differential, Gram stain, total protein level, albumin level

RUQ U/S with Doppler

Question 4

Complications

Answer 4

Encephalopathy
Hypotension
Respiratory Alkalosis
Hepatiorenal Syndrome
Bleeding
Infection
Hypoglycemia

Question 5

Management

Answer 5

ABCDE

MOVIE

IV Crytalloids

Levophed 0.01-0.3 mcg / kg / min

Consider Ceftriaxone 1 g IV for variceal bleed + SBP

Consider Albumin 1.5 mg / kg IV for SBP

Lactulose 30 ml q 2 hrs until 2 stool per day THEN 30 ml tid

N-acetylcysteine 150 mg/kg IV loading dose over 60 min THEN 50 mg / kg over 4 hrs, then 100 mg / kg over 16 hrs

Dose Adjust Hepatic Meds
D/C Acetaminophen
D/C Nephrotoxins
Decreased HTN Meds

Question 6

Disposition

Answer 6

Admission.

Consider ICU for most acute liver failure patients, especially those with higher grades of encephalopathy.

Consult nearest transplant center