fuliminant hepatic failure
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Etiology
- drug hepatotoxicity
- acetaminophen toxicity, ingestion > 4 grams; lower amounts may be associated with alcoholism
- isoniazid
- sulfonamides
- tetracycline
- NSAIDs
- drugs of abuse:
- pharmaceutical herbs
- black cohosh
- chaperral
- Amanita poisoning
- virus infections
- bacterial infection: Bacillus cereus
- Budd-Chiari syndrome
- pregnancy disorders
- autoimmune hepatitis
Clinical manifestations
Laboratory
- PT/PTT abnormal
- liver function tests may be abnormal
- plasma NH3 may be elevated
- serum acetaminophen
- hepatitis A serology
- hepatitis B serology
- do NOT perform liver biopsy
- dangerous
- not associated with improved outcomes
Radiology
- CT of head for to look for intracerebral hemorrhage
Management
- fresh frozen plasma for coagulopathy
- arteriovenous hemofiltration with or without hemodialysis supports renal function
- lactulose for encephalopathy
- mannitol for elevated intracranial pressure
- corticosteroids not indicated
- barbiturate-induced coma not indicated
- contraindicated in renal failure
- N-acetyl cysteine for acetaminophen toxicity
- liver transplantation
- transplantation centers monitor intracranial pressure for cerebral edema due to hepatic encephalopathy
- mechanical liver assistance does not extend survival
More general terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 14, 16. American College of Physicians, Philadelphia 2006, 2012
- ↑ O'Grady JG et al, Fulminant hepatic failure. In: Diseases of the Liver, Schiff L, Schiff R (eds), JB Lippincott, Philadelphia 1993
- ↑ Ichai P, Samuel D. Etiology and prognosis of fulminant hepatitis in adults. Liver Transpl. 2008 Oct;14 Suppl 2:S67-79 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18825677