Treatment
Etiologies Viral
ÎTreat viral hepatitis A- (and E-) related acute liver failure with supportive care since no virus-specific treatment has proven to be effective (III).
ÎConsider nucleos(t)ide analogues (NAs) for hepatitis B-associated acute liver failure and for prevention of post-transplant recurrence (III).
ÎTreat 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
ÎFor patients with known or suspected acetaminophen overdose within 4 hours of presentation, give activated charcoal just prior to starting NAC (I).
ÎBegin 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).
ÎNAC 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)
ÎN-acetylcysteine may be beneficial for acute liver failure due to drug- induced liver injury (I).
ÎObtain 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).
ÎDetermine ingredients of non-prescription medications whenever possible (III).
Mushroom Poisoning
ÎIn ALF patients with known or suspected mushroom poisoning, consider administration of penicillin G and N-acetylcysteine (III).
ÎList patients with acute liver failure secondary to mushroom poisoning for transplantation, since this procedure is often the only lifesaving option (III).
Pregnancy
ÎFor 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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