Diagnosis and Assessment
ÎThe precise etiology of ALF should be sought to guide further management decisions (III).
ÎIf 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).
ÎHospitalize patients with ALF and monitor frequently, preferably in an ICU (III). (See Table 4)
ÎAny patient with altered mental status warrants admission to an intensive care unit (ICU) since the condition may deteriorate quickly.
ÎManagement consists of intensive care support after treatments for specific etiologies have been initiated.
ÎPay careful attention to fluid management, hemodynamics and metabolic parameters as well as surveillance for, and treatment of, infection.
ÎCheck coagulation parameters, complete blood counts, metabolic panels (including glucose) and arterial blood gases frequently.
ÎIn the setting of acute liver failure due to possible drug hepatotoxicity, discontinue all but essential medications (III).
ÎInitiate contact with a transplant center and plan to transfer appropriate patients with ALF early in the evaluation process (III). (See Table 5)
2
