#EMConf: Acute Hepatic Failure
General: Severe liver disease in a patient without preexisting cirrhosis with encephalopathy and impaired synthetic functions.
Etiology: Most common cause is Acetaminophen toxicity; viral hepatitis and drug reactions are also very common.
-CBC, Chem 7 → look for thrombocytopenia and need Cr for MELD score
-Coagulation Studies → to assess synthetic function of liver.
-LFT’s, ALK-P, bilirubin and Albumin.
-Tylenol, Viral Hepatitis
-Mostly supportive; treat the underlying etiology.
-Early consultation to transplant center v. hepatology v. GI.
-D5NS preferred as these patients are prone to hypoglycemia.
-Lactulose and Rifaximin for Hepatic Encephalopathy.
-Consider Phenytoin over benzos for seizure to prevent benzo overdose secondary to depressed hepatic clearance.
-Monitor for coagulopathy and thrombocytopenia.
-Paracentesis and ceftriaxone if concerned for Spontaneous Bacterial Peritonitis (SBP).
-Major cause of death in Acute Liver Failure is cerebral edema and intracranial hypertension.
Bailey, C, Hern HG. Hepatic Failure: An Evidence-Based Approach In The Emergency Department. Emergency Medicine Practice. Vol. 12, No. 4, 2014.
Oyama, LC: Disorders of the Liver and Biliary Tractin Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 107: p 1186-1204