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