Liver Failure, Acute
Description General Measures Medicine Treatment Referral ICD-10 code: K72.0/K72.9 DESCRIPTION Acute liver failure refers to the development of severe acute liver injury with encephalopathy and impaired synthetic function (INR of ≥1.5) in a patient without cirrhosis or pre-existing liver disease. There are many causes, but the commonest are viral hepatitis, alcohol, drug-induced liver injury
ICD-10 code: K72.0/K72.9
DESCRIPTION
Acute liver failure refers to the development of severe acute liver injury with encephalopathy and impaired synthetic function (INR of ≥1.5) in a patient without cirrhosis or pre-existing liver disease. There are many causes, but the commonest are viral hepatitis, alcohol, drug-induced liver injury, toxins or ischaemic hepatitis.
GENERAL MEASURES
- Patient education.
- Avoid hepatotoxic drugs and alcohol.
- Rest and reduce physical activity.
- Protein restriction is indicated for encephalopathy, however, severe protein restriction may accentuate catabolism. Use increments of 20 g protein per day, aiming for 1 g/kg/day as tolerated.
- Monitor blood glucose regularly because hypoglycaemia is common.
- Correct electrolyte disturbances.
- Exclude GI bleed and infection.
- Avoid factors (especially medications) that may worsen or precipitate functional deterioration.
- Avoid vigorous paracentesis.
- If the patient is bleeding, check INR and correct coagulopathy with FFP or lyophilised plasma.
MEDICINE TREATMENT
• Lactulose, oral, 10–30 mL 8 hourly, titrated to attain 2–3 soft stools per day.
Note:
Do not give antibiotics unless there is evidence of bacterial sepsis.
REFERRAL
- All cases of severe acute liver failure should be discussed with a specialist.
Click here for the NEMLC Recommendations for medicine treatement (2020-4 review cycle).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level, 2020-4_Version 1_July 2024
Chapter 1: Alimentary tract; 1.2 Hepatic Disorders; 1.2.2 Liver Failure, Acute