Pitfalls

There are, however, some hidden hazards that should be avoided:

• Failing to differentiate between acute liver failure and decompensated chronic liver failure
• Failing to appreciate the severity and likely clinical deterioration of patients with acute liver failure
• Missing the subtle signs of grade I encephalopathy
• Failing to alert the transplant and ICU teams early
• Failing to maintain a high index of suspicion for paracetamol poisoning in all acute liver failure patients
• Consideration to administration of N-acetylcysteine to all patients in whom paracetamol poisoning cannot be confidently ruled out