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
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