Diagnosis and Assessment
����The precise etiology of ALF should be sought to guide further
management decisions (III).
����If the etiological diagnosis remains elusive after extensive initial
evaluation, liver biopsy may be appropriate to attempt to identify a
specific etiology that might influence treatment strategy (III).
����Hospitalize patients with ALF and monitor frequently, preferably in an
ICU (III). (See Table 4)
����Any patient with altered mental status warrants admission to an
intensive care unit (ICU) since the condition may deteriorate quickly.
����Management consists of intensive care support after treatments for
specific etiologies have been initiated.
��Pay careful attention to fluid management, hemodynamics and metabolic
��
parameters as well as surveillance for, and treatment of, infection.
����Check coagulation parameters, complete blood counts, metabolic
panels (including glucose) and arterial blood gases frequently.
����In the setting of acute liver failure due to possible drug hepatotoxicity,
discontinue all but essential medications (III).
����Initiate contact with a transplant center and plan to transfer
appropriate patients with ALF early in the evaluation process (III).
(See Table 5)
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