Acute Liver Failure

# Acute Liver Failure
Patient without history of liver dysfunction who presents with INR >1.5 and encephalopathy concerning for ALF. Should this be ALF, etiologies include viral, tox, autoimmune, vascular, shock, and iatrogenic med effect. Will proceed with broad diagnostics and evaluation for altered mental status. If this is not acute liver failure, may be acute liver injury from similar reasons listed above, with INR elevation from poor nutrition, DIC, MAHAs, or anticoagulation.
Dx
- RUQ with Doppler
- APAP level, arterial ammonia
- Hepatitis A IgM, anti-HBC IgM, anti-HCV IgG, HCV RNA,
- HBsAg, HBsAb, HBcAb, HBV DNA,
- ANA, ASMA, IgG, ceruloplasmin, and Utox
- INR, LFTs BID
- Q2hr POC Glucose
Tx
- Appreciate Liver Transplant Unit assistance
- NAC
- Elevate Head of bed
- 2g APAP limit