Acute Liver Failure

Acute Liver Failure (ALF)

• Characteristic feature: No specific definition, but a combination of clinical and biochemical features

Management of ALF Patients

• Patients with grade 3 encephalopathy: Intensive care unit (ICU) admission recommended
• Treatment of encephalopathy: No recommendation for lactulose or rifaximin use
• Patients with grade 2 or higher hepatic encephalopathy: Hyperammonemia management involves reduction of ammonia production and enhancement of ammonia removal

Coagulopathy Management

• INR correction: Not recommended in the absence of active bleeding or impending high-risk procedure
• More accurate assessment of coagulopathy: Viscoelastic tests (e.g., thromboelastography) compared to INR

Treatment of ALF Patients

• Patients with grade 2 or higher encephalopathy: Consideration for ICU admission and urgent evaluation for liver transplantation
• First-line vasopressor for hypotension refractory to fluid resuscitation: Norepinephrine
• Secondary agent for hypotension not responsive to norepinephrine: Vasopressin
• Patients with ALF due to mushroom poisoning: Silibinin treatment initiation
• Patients with non-APAP ALF: Initial treatment with N-acetylcysteine (NAC) not recommended
• Patients with ALF and Hepatic Encephalopathy Grade 1: Close monitoring and supportive care

Infection Management

• Early assessment for infection: Prudent due to high risk of bacterial infections
• Prophylactic antibiotics: Not recommended for routine use in patients with ALF

Test your knowledge of acute liver failure in the emergency department with this quiz. Explore the causes, symptoms, and guidelines for managing this life-threatening condition, including the impact of mushroom experimentation and over-the-counter herbal supplements.