K72.0/K72.9
DESCRIPTION
Acute liver failure refers to the development of severe acute liver injury with encephalopathy and impaired synthetic function (INR of ≥1.5) in a patient without cirrhosis or pre-existing liver disease. There are many causes, but the commonest are viral hepatitis, alcohol, drug-induced liver injury, toxins or ischemic hepatitis.
GENERAL MEASURES
Patient education.
Avoid hepatotoxic drugs and alcohol.
Rest and reduce physical activity.
Protein restriction indicated for encephalopathy. Severe protein restriction may accentuate catabolism. Use increments of 20 g protein per day as tolerated.
Monitor blood glucose regularly because hypoglycaemia is common.
Correct electrolyte disturbances.
Exclude GI bleed as precipitant.
Avoid any measure, e.g. medications that may worsen or precipitate functional deterioration.
Avoid vigorous paracentesis.
Exclude infection as precipitant.
If the patient is bleeding, check INR and correct coagulopathy with FFP or lyophilised plasma. Routine administration of parenteral vitamin K1 is of unproven value.
MEDICINE TREATMENT
- Lactulose, oral, 10–30 mL 8 hourly, titrated to attain 2–3 soft stools per day.
Do not give antibiotics unless there is evidence of bacterial sepsis.
REFERRAL
All cases of severe acute liver failure should be discussed with a specialist.