Acute Liver Failure - Treatment

Treatment

King's College Hospital criteria

for liver transplantation in acute liver failure
Patients with paracetamol toxicity

pH < 7.3 or
Prothrombin time > 100 seconds and
serum creatinine level > 3.4 mg/dL (> 300 μmol/l)
if in grade III or IV encephalopathy
Other patients

Prothrombin time > 100 seconds or
Three of the following variables:

  • Age < 10 yr or > 40 years
  • Cause:
    • non-A, non-B hepatitis
    • halothane hepatitis
    • idiosyncratic drug reaction
  • Duration of jaundice before encephalopathy > 7 days
  • Prothrombin time > 50 seconds
  • Serum bilirubin level > 17.6 mg/dL (> 300 μmol/l)

Treatment involves admission to hospital. Often, intensive care unit admission or very close observation is required. Supportive treatment is with adequate nutrition, optimalisation of the fluid balance, mechanical ventilation and intracranial pressure monitoring (in severe encephalopathy), and treatment aimed at removing the underlying cause (such as acetylcysteine for paracetamol poisoning). Other supportive measures may include the drainage of ascites.

While many people who develop acute liver failure recover with supportive treatment, liver transplantation is often required in people who continue to deteriorate or have adverse prognostic factors.

"Liver dialysis" (various measures to replace normal liver function) is evolving as a treatment modality, and is gradually being introduced in the care of patients with liver failure.

Read more about this topic:  Acute Liver Failure

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