Acute liver failure resident survival guide: Difference between revisions
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===General Management=== | ===General Management=== | ||
{{familytree/start |summary=PE diagnosis Algorithm.}} | {{familytree/start |summary=PE diagnosis Algorithm.}} | ||
{{familytree | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | | | | | | | | |A01=Continuous monitoring under quite environment w/ preventive treatment strategies}} | ||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | | | |}} | ||
{{familytree | {{familytree | |,|-|-|-|-|v|-|-|-|-|v|-|-|-|-|v|-|-|-|-|v|-|-|-|-|+|-|-|-|-|v|-|-|-|-|v|-|-|-|-|v|-|-|-|-|v|-|-|-|-|.| |}} | ||
{{familytree | {{familytree | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| |}} | ||
{{familytree | {{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 | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| | | | |!| |}} | ||
{{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|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=== | ===Etiology Specific Management=== | ||
Revision as of 06:22, 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 | w/ or progression to grade I/II hepatic encephalopathy | Transfer to transplant center | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 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
| 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||