Acute Liver Acute Liver Failure Rapidly progressive lifethreatening

Acute Liver

Acute Liver Failure Rapidly progressive life-threatening condition • Liver injury in a patient with no pre-existing liver disease • Common causes; Paracetamol overdoses, autoimmune disease Patients often appear well but can rapidly deteriorate

Referrals to Liver Unit • Discuss with Regional Liver Units e. g Royal Free or Kings • Definition : Coagulopathy + hepatic encephalopathy + deranged liver function. Consider how best to transfer

General treatment • Fluid Resuscitation then Noradrenaline as needed • N-acetylcysteine (parvolex) for liver protection • Hypoglycaemia is common – hourly BMs • Avoid 5% Dextrose – risk of cerebral oedema • Infusion of 20% or boluses of 50% Dextrose

Neurology Patients can rapidly deteriorate from Grade 1 to Grade 4 Risk of death is due to Neurological complications e. g. Cerebral oedema West Haven Criteria Grade 1 – euphouria, anxiety Grade 2 – lethargic, disorientation Grade 3 – confusion, responsive to verbal stimuli Grade 4 – coma Targets; p. C 02 4. 5 -5, p 02 >10, Head up 30 o, neutral head position, target Na >145

Interventional Radiology • E. g. Obstetrics, Gastrointestinal bleeding • Consider where best to arrive especially if bleeding • Interventional Radiology is often in remote area • Consider pre-booking to obtain hospital number • Transfer with blood products, Txacid, vit K • Wide bore iv access • negative blood available at destination O

Acute Gastro Referrals • Usually for upper GI Bleeding • Often had local attempt at OGD • They need airway protection for the transfer if not already intubated • Ongoing bleeding consider SSB tube

Sengstaken Blakemore tube

Summary • Liver patients • high risk of deterioration • often become encephalopathic • consider intubation pre-transfer • Bleeding patients – • Liase where to arrive to especially Interventional Radiology • Transfer with blood products