UMEM Educational Pearls

Category: Critical Care

Title: Acute Liver Failure

Posted: 5/17/2011 by Mike Winters, MD (Updated: 4/19/2024)
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Acute Liver Failure (ALF)

ALF is defined as sudden and severe liver failure in a patient without preexisting liver disease.
The clinical presentation can include altered mental status, coagulopathy, MODS, & cerebral edema.
In the US, the most common cause of ALF is drug-induced (e.g. acetaminophen).
Important components of the ED management of patients with ALF include:
- Monitoring and correcting hypoglycemia (may need infusion of D20)
- Monitoring and maintaining a normal sodium concentration
- Volume resuscitation with isotonic crystalloids or colloids
- Prophylactic administration of broad spectrum antibiotics (given high incidence of sepsis)
- Consideration for continuous veno-venous hemodiafiltration (CVVHD) for severe elevations in ammonia and acidosis (even if renal function is normal)
- Transfer to center capable of liver transplantation

Larsen FS, Bjerring PN. Acute liver failure. Curr Opin Crit Care 2011; 17:160-4.