Acute liver failure resident survival guide: Difference between revisions

Revision as of 06:08, 8 December 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Management

Altered mental status & PT prolongation by 4-6 sec or INR ≥1.5
presenting w/ nonspecific abdominal Sx
w/o preexisting chronic liver disease, cirrhosis & any illness of <26 wks duration

Acute liver failure

Mandatory hospital admission

w/o altered mental status, significant coagulopathy & abnormal LFT

w/ altered mental status

High dependency ward admission

Worsening mental status

ICU admission

Initial evaluation:
Detailed H/o and PE
Labs: CBC, PT/INR, serum BCH, ABG, ammonia, acetaminophen & tox screen for other drugs/toxins, viral serology (A-E), autoimmune markers, amylase, lipase, *bilirubin:alkaline phosphatase, blood grouping & typing, HIV status

General management

Etiology specific management

Complication specific management

General Management

Etiology Specific Management

Complication Specific Management

Do's

Dont's

References

Template:WikiDoc Sources

Continuous monitoring under quite environment w/ preventive treatment strategies

Cerebral edema & increased ICP

Coagulopathy

Drugs

GI bleeding

Hemodynamic instability

Hepatic encephalopathy

Infections

Metabolic disturbances

NAC

Nutritional deficiency

Renal failure

*Monitor ICP, CPP, cerebral oxygenation
*Elevate head end to 30°
*Monitor fluid status
*3% NS
*Avoid NGT and suction

*Platelet count & coagulation profile (12th hourly)
*Inj. Vit. K
*Cryoprecipitate

*Discontinue medications
*Avoid nephrotoxic & hepatotoxic drugs

*Ranitidine

*Monitor CVP w/ central venous catheter*

*Frequent monitoring of mental status

*CBC (12th hourly)*
CXR; sputum, blood & urine cultures (daily)
*Cefotaxime, meropenem, fluconazole or vancomycin

*Serum BCH, ABG, lactate (12th hourly)
*Serum glucose (2nd hourly)

*NAC (i.v × 2d then P.O.)

*Eternal feeding
*Parental feeding

*Urinary I/O

@@ Line 35: / Line 35: @@
 {{familytree | | | | | | | | | | | B01 | | | B02 | | | B03 | | | B04 | | | B05 | | | B06 | | | B07 | | | B08 | | | B09 | | | B10 | | | B11 |B01=Cerebral edema & increased ICP|B02=Coagulopathy|B03=Drugs|B04=GI bleeding|B05=Hemodynamic instability|B06=Hepatic encephalopathy|B07=Infections|B08=Metabolic disturbances|B09=NAC|B10=Nutritional deficiency|B11=Renal failure}}
 {{familytree | | | | | | | | | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| |}}
-{{familytree | | | | | | | | | | | C01 | | | C02 | | | C03 | | | C04 | | | C05 | | | C06 | | | C07 | | | C08 | | | C09 | | | C10 | | | C11 |C01=*Monitor ICP, CPP, cerebral oxygenation<BR>*Elevate head end to 30°<BR>*Monitor fluid status<BR>*3% NS<BR>*Avoid NGT and suction|C02=*Platelet count & coagulation profile (12th hourly)<BR>*Inj. vit K<BR>*Cryoprecipitate|C03=*Discontinue medications<BR>*Avoid nephrotoxic & hepatotoxic drugs|C04=*Ranitidine|C05=*Monitor CVP w/ central venous catheter*<BR>|C06=*Frequent monitoring of mental status|C07=*CBC (12th hourly)*<BR>CXR; sputum, blood & urine cultures (daily)<BR>*Cefotaxime, meropenem, fluconazole or vancomycin|C08=*Serum BCH, ABG, lactate (12th hourly)<BR>*Serum glucose (2nd hourly)|C09=*NAC (i.v × 2d then P.O.)|C10=*Eternal feeding<BR>*Parental feeding|C11=*Urinary I/O}}
+{{familytree | | | | | | | | | | | C01 | | | C02 | | | C03 | | | C04 | | | C05 | | | C06 | | | C07 | | | C08 | | | C09 | | | C10 | | | C11 |C01=*Monitor ICP, CPP, cerebral oxygenation<BR>*Elevate head end to 30°<BR>*Monitor fluid status<BR>*3% NS<BR>*Avoid NGT and suction|C02=*Platelet count & coagulation profile (12th hourly)<BR>*Inj. Vit. K<BR>*Cryoprecipitate|C03=*Discontinue medications<BR>*Avoid nephrotoxic & hepatotoxic drugs|C04=*Ranitidine|C05=*Monitor CVP w/ central venous catheter*<BR>|C06=*Frequent monitoring of mental status|C07=*CBC (12th hourly)*<BR>CXR; sputum, blood & urine cultures (daily)<BR>*Cefotaxime, meropenem, fluconazole or vancomycin|C08=*Serum BCH, ABG, lactate (12th hourly)<BR>*Serum glucose (2nd hourly)|C09=*NAC (i.v × 2d then P.O.)|C10=*Eternal feeding<BR>*Parental feeding|C11=*Urinary I/O}}
 ===Etiology Specific Management===