Selecting a Treatment Regimen
Figure 2. Acute Liver Failure
Infection
Coagulopathy
Bleeding
Frequent cultures
������ Replacement for
thrombocytopenia or
��� INR if hemorrhage
or planned invasive
procedures
������ Vitamin K 5-10 mg SQ
Consider H2-blocker
or PPI
Prompt antibiotics
Metabolic
Hemodynamics ��� Renal Failure
Maintain and
monitor:
������ Nutrition
������ Glucose,
phosphate,
potassium and
magnesium levels
Continuous, not
intermittent,
dialysis (if needed)
Rapid and
sustained fluid
replacement
GOAL
MAP ��� 75 mmHg
CPP 60-80 mmHg
Vasopressors
������ Norepinephrine
������ Vasopressin
������ Terlipressin
CNS
Preferred
Monitor ICP
Cautious
lactulose
OR
Encephalopathy I-II
Hourly
neurological exam
Encephalopathy III-IV
Risk of cerebral edema
Seizures
Endotracheal
intubation
ICH
Hypertonic saline ���
[Na] 145-155 mEqu/L
10
Mannitol bolus
0.5-1.0 gm/kg
Phenytoin and short
half-life benzodiazepines
