Treatment
Etiologies
Viral
����Treat viral hepatitis A- (and E-) related acute liver failure with
supportive care since no virus-specific treatment has proven to be
effective (III).
����Consider nucleos(t)ide analogues (NAs) for hepatitis B-associated
acute liver failure and for prevention of post-transplant recurrence (III).
����Treat patients with known or suspected herpes virus or varicella zoster
as the cause of acute liver failure with acyclovir (5-10 mg/kg IV every
8 hours) and consider them for transplantation (III).
Acetaminophen
��For patients with known or suspected acetaminophen overdose within 4
��
hours of presentation, give activated charcoal just prior to starting NAC (I).
����Begin NAC promptly in all patients where the quantity of
acetaminophen ingested, serum drug level or rising
aminotransferases indicate impending or evolving liver injury (II-1).
����NAC may be used in cases of acute liver failure in which
acetaminophen ingestion is possible or when knowledge of
circumstances surrounding admission is inadequate but
aminotransferases suggest acetaminophen poisoning (III).
Drug-Induced Liver Injury (See Table 1)
����N-acetylcysteine may be beneficial for acute liver failure due to druginduced liver injury (I).
����Obtain details (including onset of ingestion, amount and timing of last
dose) concerning all prescription and non-prescription drugs, herbs
and dietary supplements taken over the past year (III).
����Determine ingredients of non-prescription medications whenever
possible (III).
Mushroom Poisoning
����In ALF patients with known or suspected mushroom poisoning,
consider administration of penicillin G and N-acetylcysteine (III).
����List patients with acute liver failure secondary to mushroom poisoning
for transplantation, since this procedure is often the only lifesaving
option (III).
Pregnancy
����For acute fatty liver of pregnancy or the HELLP syndrome, expeditious
delivery of the infant is recommended. Consider transplantation if
hepatic failure does not resolve quickly following delivery (III).
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