Management of other complications of acute liver failure

The following checks and treatment should be carried out:

Sepsis

Regular surveillance and culturing for occult or frank sepsis.

Prophylactic antibiotics and antifungals do not improve outcome but may occasionally be considered.

Coagulopathy

Most centres routinely give vitamin K but give …
  • FFP only if …
active bleeding and INR >1.5 or INR >7
  • Platelets if …
<10 000 or <50 000 and needing invasive procedure or bleeding

This is used as a marker of liver function therefore should not be routinely corrected [1].

GI bleeding

Give prophylactic H2 blockers to all ventilated patients as evidence shows they reduce the incidence of GI bleeds [1].

Critical care management in a specialist tertiary referral unit is recommended for most patients with acute liver failure

Haemodynamic support

  • Maintain adequate intravascular volume
  • Use CVVH for acute renal failure
  • Systemic vasopressors may be required to keep MAP >60-65

Learning bite

Critical care management in a specialist tertiary referral unit is recommended for most patients with acute liver failure.

Metabolic concerns

Commence early nutritional support (preferably enteral otherwise parenteral).

Correct levels for:

  • Glucose
  • Magnesium
  • Phosphate
  • Potassium

Learning bite

Critical care management in a specialist tertiary referral unit is recommended for most patients with acute liver failure.

Transplant

List patient early if poor prognostic factors or predicted clinical course.

Learning bite

Critical care management in a specialist tertiary referral unit is recommended for most patients with acute liver failure.

In the highest risk for cerebral edema, the prophylactic induction of hypernatremia with hypertonic saline to a sodium level of 145-155 mEq/L is recommended