Acute Liver Failure Flashcards
When should APAP levels be checked after suspected ingestion?
At 4 and 16 hours. Levels above 150 at 4 hours or 18.8 after 16 hours should be started on NAC. This is for patients who are not already at-risk, such as alcoholics or malnourished.
How is acute liver failure defined?
Onset of HE, jaundice and coagulopathy (INR>1.5) in patient’s without a history of chronic liver failure.
Most common cause of ALF in US?
APAP overdose
Things to closely monitor in ALF
Hypoglycemia, hypophosphatemia, AKI, infections and HE
What is the Cushing triad in ALF?
Hypertension, bradycardia, irregular respiration
How might intracranial hypertension manifest?
CN palsies, papilledema, Cushing’s triad.
Why is the timing of NAC administration so important?
Helpful even if given up to 48 hours after APAP ingestion. Mortality is: 0.4% if given in under 12 hours 6% greater than 12 hours 13% greater than 24 hours 19% greater than 48 hours
What is the differential for acute liver failure?
Most common is APAP overdose, followed by indeterminate cases, idiosyncratic DILI and HBV infection.
Idiosyncratic DILI
Idiosyncratic (unpredictable). Most common causes are antimicrobials (particularly augmentin and sulfa), anti-epileptics (phenytoin, valproate), antituberculosis drugs (isoniazid, rifampin), NSAIDs, and azathioprine. Also consider anti fungal agents. Statin-induced ALF is extremely rare. Supplements account for about 10% of DILI
Drugs that cause DILI with a cholestatic pattern (elevated ALP)
Amoxicillin-clavulanate, carbamazepine, erythromycin and sulfonamides.
Drugs that cause DILI with a hepatocellular pattern
Allopurinol, diclofenac, isoniazid, phenytoin, and valproate.
Drugs that cause DILI with a mixed pattern
Azathioprine, enalapril and ibuprofen
