Acute liver failure laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Acute liver failure}} | {{Acute liver failure}} | ||
{{CMG}} {{AE}} | {{CMG}} {{AE}} {{HS}} | ||
==Overview== | ==Overview== | ||
All patients with clinical or laboratory evidence of moderate to severe acute hepatitis should have an immediate measurement of prothrombin time and careful evaluation of mental status. If the prothrombin time is prolonged | Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease. All patients with clinical or laboratory evidence of moderate to severe acute [[hepatitis]] should have an immediate measurement of [[prothrombin time]] and careful evaluation of [[mental status]]. If the [[prothrombin time]] is prolonged (INR ≥1.5) and there is any evidence of altered [[sensorium]], the diagnosis of acute liver failure should be strongly suspected and hospital admission is mandatory. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
* | * Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease.<ref name="Polson">{{cite journal |author=Polson J, Lee WM |title=AASLD position paper: the management of acute liver failure |journal=Hepatology |volume=41 |issue=5 |pages=1179-97 |year=2005 |pmid=15841455 |doi=10.1002/hep.20703}}</ref><ref name="pmid16775039">{{cite journal| author=Wasley A, Fiore A, Bell BP| title=Hepatitis A in the era of vaccination. | journal=Epidemiol Rev | year= 2006 | volume= 28 | issue= | pages= 101-11 | pmid=16775039 | doi=10.1093/epirev/mxj012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16775039 }} </ref><ref name="pmid12753342">{{cite journal |vauthors=Khuroo MS, Kamili S |title=Aetiology and prognostic factors in acute liver failure in India |journal=J. Viral Hepat. |volume=10 |issue=3 |pages=224–31 |year=2003 |pmid=12753342 |doi= |url=}}</ref><ref name="pmid22271089">{{cite journal| author=Torres HA, Davila M| title=Reactivation of hepatitis B virus and hepatitis C virus in patients with cancer. | journal=Nat Rev Clin Oncol | year= 2012 | volume= 9 | issue= 3 | pages= 156-66 | pmid=22271089 | doi=10.1038/nrclinonc.2012.1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22271089 }} </ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |LAB | ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |LAB | ||
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| align="center" style="background:#DCDCDC;" + | | | align="center" style="background:#DCDCDC;" + | | ||
* [[Prothrombin time]]/INR | * [[Prothrombin time]]/[[INR]] | ||
| | | | ||
* Increased | * Increased | ||
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* Prolonged prothrombin time, resulting in an INR ≥1.5; it shows coagulopathy which is a part of acute liver failure criteria. | * Prolonged [[prothrombin time]], resulting in an INR ≥1.5; it shows [[coagulopathy]] which is a part of acute liver failure criteria. | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" + | | | align="center" style="background:#DCDCDC;" + | | ||
| Line 26: | Line 24: | ||
* Low | * Low | ||
| | | | ||
* Anemia may be present | * [[Anemia]] may be present | ||
|- | |- | ||
| colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + | | | colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + | | ||
**Liver function tests | **[[Liver function tests]] ([[Aspartate transaminase|AST]], [[Alanine transaminase|ALT]], [[alkaline phosphatase]], [[Gamma-glutamyl transpeptidase|GGT]]) | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* Elevated | * Elevated | ||
| | | | ||
* Liver enzymes are elevated in acute liver failure. The decrease in liver enzymes may indicate recovery or worsening of liver failure and an indication | * [[Liver enzymes]] are elevated in acute liver failure. The decrease in liver enzymes may indicate recovery or worsening of liver failure and an indication of hepatic mass loss. | ||
|- | |- | ||
| | | | ||
* Total [[bilirubin]] | * Total [[bilirubin]] | ||
| | | | ||
* Elevated | * Elevated | ||
| | | | ||
* Bilirubin and PT/INR | * [[Bilirubin]] and [[INR|PT/INR]] will continue to rise in liver failure but if a patient is improving, bilirubin and PT/INT will also improve. | ||
|- | |- | ||
| | | | ||
* Albumin | * [[Albumin]] | ||
| | | | ||
* Low | * Low | ||
| | | | ||
* Albumin indicates the synthetic function of the liver. | * [[Albumin]] indicates the synthetic function of the liver. | ||
|- | |- | ||
| colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + | | | colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + | | ||
**Blood glucose | **[[Blood sugar|Blood glucose]] | ||
| colspan="1" rowspan="1" | | | colspan="1" rowspan="1" | | ||
* Low | * Low | ||
| | | | ||
* Decrease hepatic glycogenolysis and gluconeogenesis | * Decrease hepatic [[glycogenolysis]] and [[gluconeogenesis]] | ||
|- | |- | ||
| | | | ||
* BUN and CR | * [[Blood urea nitrogen|BUN and CR]] | ||
| | | | ||
* Elevated | * Elevated | ||
| | | | ||
* Decrease clearance in hepatorenal syndrome | * Decrease clearance in [[hepatorenal syndrome]] | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" + | | | align="center" style="background:#DCDCDC;" + | | ||
*Toxicology screen (acetaminophen level) | *Toxicology screen ([[Acetaminophen|acetaminophen level]]) and blood alcohol level | ||
| | | | ||
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* Detectable in acetaminophen poisioning | * Detectable in [[acetaminophen]] poisioning | ||
|- | |- | ||
| align="center" style="background:#DCDCDC;" + | | | align="center" style="background:#DCDCDC;" + | | ||
| Line 75: | Line 72: | ||
* Dectectable in viral hepatitis | * Dectectable in viral hepatitis | ||
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* Viral serology and PCR can detect the viral agent | * Viral serology and [[PCR]] can detect the viral agent | ||
|- | |- | ||
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| Line 82: | Line 79: | ||
* Detectable in auto immune hepatitis. | * Detectable in auto immune hepatitis. | ||
| | | | ||
* Antibody screen can detect antibodies associated with autoimmune hepatitis such as anti-smooth muscle antibody or ANA. | * Antibody screen can detect antibodies associated with [[autoimmune hepatitis]] such as [[anti-smooth muscle antibody]] or [[ANA]]. | ||
|- | |- | ||
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| Line 88: | Line 85: | ||
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* Elevated in wilson's disease | * Elevated in [[Wilson's disease|wilson's]] disease | ||
|- | |- | ||
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*Blood lactate | *[[Lactate|Blood lactate]] | ||
| | | | ||
* Elevated | * Elevated | ||
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* Blood lactate is elevated due to decrease hepatic clearance and ischemia to hepatic tissue | * Blood [[lactate]] is elevated due to decrease [[hepatic]] clearance and [[ischemia]] to hepatic tissue | ||
|- | |- | ||
| | | | ||
*Ammonia levels | *[[Ammonia|Ammonia levels]] | ||
| | | | ||
* Elevated | * Elevated | ||
| | | | ||
* Decrease ammonia clearance | * Decrease [[ammonia]] clearance | ||
|} | |} | ||
Latest revision as of 22:20, 1 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]
Overview
Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease. All patients with clinical or laboratory evidence of moderate to severe acute hepatitis should have an immediate measurement of prothrombin time and careful evaluation of mental status. If the prothrombin time is prolonged (INR ≥1.5) and there is any evidence of altered sensorium, the diagnosis of acute liver failure should be strongly suspected and hospital admission is mandatory.
Laboratory Findings
- Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease.[1][2][3][4]
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References
- ↑ Polson J, Lee WM (2005). "AASLD position paper: the management of acute liver failure". Hepatology. 41 (5): 1179–97. doi:10.1002/hep.20703. PMID 15841455.
- ↑ Wasley A, Fiore A, Bell BP (2006). "Hepatitis A in the era of vaccination". Epidemiol Rev. 28: 101–11. doi:10.1093/epirev/mxj012. PMID 16775039.
- ↑ Khuroo MS, Kamili S (2003). "Aetiology and prognostic factors in acute liver failure in India". J. Viral Hepat. 10 (3): 224–31. PMID 12753342.
- ↑ Torres HA, Davila M (2012). "Reactivation of hepatitis B virus and hepatitis C virus in patients with cancer". Nat Rev Clin Oncol. 9 (3): 156–66. doi:10.1038/nrclinonc.2012.1. PMID 22271089.