Acute Liver Failure

Question 1

ALF

Answer 1

characterized by a sudden insult to the liver with catastrophic consequences, usually in the absence of preexisting liver disease.

The definitions used have included a time limit between the onset of either symptoms or jaundice and the development of encephalopathy ranging from 8 weeks to 6 months

Question 2

twin cardinal features that reflect the severity of liver injury, and both are required to make the clinical diagnosis of ALF

Answer 2

Coagulopathy and encephalopathy

Question 3

One categorization based on clinical pat- terns and outcome described 3 groups based on the time interval between the onset of jaundice and encephalopathy

Answer 3

hyperacute liver failure (up to 7 days), acute liver failure (8 to 28 days), and subacute liver failure (4 to 24 weeks).

Patients with hyperacute liver failure were more likely to develop cerebral edema but also more likely to recover without LT.

Question 4

Acetaminophen

Answer 4

is a partially dose-dependent hepatotoxin with mortality rates highest at doses exceeding 48 g. Increased suscep- tibility to acetaminophen toxicity is recognized as a consequence of antiepileptic therapy, regular alcohol consumption, and malnu- trition.

Acetaminophen is also a direct toxin to other organs, particularly the kidney, and possibly the pancreas.

Question 5

Acetaminophen treatment

Answer 5

N-acetylcysteine is the substrate for glutathione repletion and is an effective anti- dote to acetaminophen if administration is commenced within 16 hours of the ingestion of acetaminophen, when serum concentrations of acetaminophen are above a time-dependent determinant of risk of liver injury.

N-acetylcysteine is also beneficial in reducing the severity of liver injury with later administration

Question 6

King’s College Hospital Indicators of a Poor Prognosis in ALF

Answer 6

ACETAMINOPHEN CASES
Arterial pH <7.25 more than 24 hr after drug ingestion* All of the following:
Prothrombin time >100 sec or INR >6.5
Serum creatinine level >3.4 mg/dL (300 μmol/L) or anuria Grade 3-4 encephalopathy

Question 7

King’s College Hospital Indicators of a Poor Prognosis in ALF

Answer 7

NONACETAMINOPHEN CASES
Prothrombin time >100 sec or INR >6.7 Any 3 of the following:
Unfavorable etiology (seronegative hepatitis or drug reaction) Age <10 or >40 yr
Acute or subacute category (duration of jaundice >7 days) Serum bilirubin level >17.5 mg/dL (300 μmol/L)
Prothrombin time >50 sec or INR >3.5