Acute liver failure laboratory findings

Acute liver failure Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Acute Liver Failure from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Acute liver failure laboratory findings On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Acute liver failure laboratory findings All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Acute liver failure laboratory findings
CDC on Acute liver failure laboratory findings
Acute liver failure laboratory findings in the news
Blogs on Acute liver failure laboratory findings
Directions to Hospitals Treating Acute liver failure
Risk calculators and risk factors for Acute liver failure laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:

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 by ≈ 4-6 seconds or more (INR ≥1.5) and there is any evidence of altered sensorium, the diagnosis of ALF should be strongly suspected and hospital admission is mandatory.

Laboratory Findings

LAB	values in Acute liver failure	Comments
Prothrombin time/INR	Increased	Prolonged prothrombin time, resulting in an INR ≥1.5; it shows coagulopathy which is a part of acute liver failure criteria.
Hemoglobin
Liver function tests AST, ALT, alkaline phosphatase, GGT, total bilirubin, albumin	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 of loss of hepatic mass. Bilirubin and PT/INR will will continue to rise in liver failure but if patient is improving, bilirubin and PT/INT will also improve.
Blood glucose
Amylase and lipase
Arterial blood gas, lactate
Acetaminophen level, Toxicology screen
Viral hepatitis serologies: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HEV
Autoimmune markers: ANA, ASMA, LKMA, Immunoglobulin levels
Ceruloplasmin Level ( when Wilson's disease suspected)
Pregnancy test (females)
Ammonia (arterial if possible)
HIV status (has implication for transplantation)

Initial laboratory examination must be extensive in order to evaluate both the etiology and severity..

Initial laboratory analysis

• Prothrombin time/INR
• Complete blood count
• Chemistries
  • Liver function test: AST, ALT, alkaline phosphatase, GGT, total bilirubin, albumin
  • Creatinine, urea/blood urea nitrogen, sodium, potassium, chloride, bicarbonate, calcium, magnesium, phosphate
  • glucose
  • Amylase and lipase
• Arterial blood gas, lactate
• Blood type and screen
• Paracetamol (Acetaminophen) level, Toxicology screen
• Viral hepatitis serologies: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HEV
• Autoimmune markers: ANA, ASMA, LKMA, Immunoglobulin levels
• Ceruloplasmin Level ( when Wilson's disease suspected)
• Pregnancy test (females)
• Ammonia (arterial if possible)
• HIV status (has implication for transplantation)