UMEM Educational Pearls

Category: Critical Care

Title: Acute Liver Failure

Posted: 11/27/2007 by Mike Winters, MD (Updated: 10/20/2020)
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Acute Liver Failure

  • Acute liver failure (ALF) is defined as the onset of encephalopathy and coagulopathy within 26 weeks of jaundice in a patient without prior history of liver disease
  • ALF has an extremely high mortality
  • The most common cause of ALF include Tylenol, HSV, autoimmune hepatitis, HBV, and acute fatty liver of pregnancy/HELLP
  • Complications EPs are likely to see/manage include hepatic encephalopathy, infection, circulatory dysfunction, bleeding, and seizures
  • Fungal infections may be present in one-third of patients with ALF (Candida)
  • Non-convulsive seizure activity occurs in a high proportion of patients with ALF and encephalopathy - consider EEG for severly encephalopathic patients and those with a sudden deterioration in neuro status

Stravitz RT, et al. Intensive care of patients with acute liver failure. Crit Care Med 2007;35:2498-2508.