Table 2. Initial Laboratory Analysis
Chemistries: sodium, potassium, chloride, bicarbonate, calcium, magnesium,
phosphate, glucose, AST, ALT, alkaline phosphatase, GGT, total bilirubin, albumin,
creatinine, blood urea nitrogen
Viral hepatitis serologies: anti-HAV IgM, HBsAg, anti-HBc IgM, antiHEVa, anti-HCV,
HCV RNAb, HSV1 IgM, VZV
Autoimmune markers: ANA, ASMA, immunoglobulin levels
Arterial blood gas
Ceruloplasmin levelc
Arterial lactate
Pregnancy test (females)
Complete blood count
Ammonia (arterial if possible)
Blood type and screen
HIV-1, HIV-2d
Acetaminophen level
Amylase and lipase
Toxicology screen
Prothrombin time/INR
If clinically indicated.
b
Done to recognize potential underlying infection.
c
Done only if Wilson disease is a consideration (eg, in patients < 40 years without another obvious
explanation for ALF). In this case uric acid level and bilirubin to alkaline phosphatase ratio may be
helpful as well.
d
Implications for potential liver transplantation.
a
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