Diagnosis :
Criteria for Diagnosis in Adults
When a patient presents with Jaundice < 26 weeks and on examination has encephalopathy with no stigmata of chronic liver disease. On evaluation has Coagulopathy (INR>1.5) patient is said to have acute liver failure. While the viral cause remains the commonest etiology an alternative diagnosis must be sought.
Approach :
After a careful history from the attendants proceed with the following investigations: Never miss Malaria, poison intake, Leptospira and scrub typhus, etc
Criteria for Diagnosis in Adults
When a patient presents with Jaundice < 26 weeks and on examination has encephalopathy with no stigmata of chronic liver disease. On evaluation has Coagulopathy (INR>1.5) patient is said to have acute liver failure. While the viral cause remains the commonest etiology an alternative diagnosis must be sought.
Approach :
After a careful history from the attendants proceed with the following investigations: Never miss Malaria, poison intake, Leptospira and scrub typhus, etc
- Hemogram, RFT, LFT, INR, ECG
- Monitoring of Blood sugars
- Arterial blood gas
- Arterial ammonia
- Blood culture
- IgM anti HAV,HBsAg,anti-HBc ,IgM,anti HEV,anti HCV
- If Wilson suspected: Ceruloplasmin levels, KFRing/Urinary copper
- When there is an abnormal neurological examination proceed with Brain imaging (CT/MRI)
- Pregnancy test in females childbearing age group.
Management :
- Please admit the patient in an ICU
Supportive treatment
- Infection: Surveillance & Prompt treatment as infection increases mortality
- Coagulopathy : (Although the role is debatable )Injection Vit.K 10mg IV OD for 3 days
- Transfuse platelets/FFP for invasive procedures /active bleeding
- Injection PPI 20mg IV BD for stress ulcers
- Volume replacement
- Pressure support
Disease-specific :
Grade I, II hepatic encephalopathy
- IV -NAC: 150mg/kg in D5 over 15 min,
- then 50 mg/kg given over 4hrs
- followed by 100mg/kg over 16hrs in patients
HBV: Entecavir,0.5mg once daily through Ryles tube
Autoimmune hepatitis: Prednisolone 40-60mg /day (With mild Hepatic encephalopathy)
Consider Liver transplantation :
Kings criteria for Liver transplantation :
The presence of one of the following should prompt a referral/transfer to a liver transplantation center:
- Acidosis (admission arterial pH < 7.30) OR
- Hepatic encephalopathy (grade III or IV), AND coagulopathy (PT > 100 s), AND acute kidney injury (creatinine > 3.4 mg/dL), OR
- Hyperlactatemia (4-hour lactate > 3.5 mmol/L, or 12-hour lactate > 3.0 mmol/L), OR
- Hyperphosphatemia (48-96 hour phosphate > 3.7 mg/dL) in patients with acetaminophen-induced fulminant hepatic failure.
