Advertisement

Acute Liver Failure: Diagnosis and Management for the General Intensive Care

Chapter
  • 1.4k Downloads

Abstract

Acute liver failure is a rare condition, resulting from a rapid decline in hepatic function with potentially life threatening sequelae. Detailing the definitions pertinent to the syndrome, the chapter outlines the evidence behind prognostication and the identification of patients requiring intensive care and subsequent tertiary specialist input. Exploring the evidence behind current practice, this chapter allows the general intensivist quantifiable insight upon which to base management decisions both in the initial and continuing management of such complex patients.

Keywords

Liver failure Encephalopathy Coagulopathy King’s College Criteria Intensive Care 

Summary of Abbreviations

AoCLD

Acute-on-chronic liver disease

HELLP

Haemolysis, elevated liver enzymes, low platelet count

ICP

Intracranial pressure

MHRA

Medicines and healthcare products regulatory agency

PEEP

Positive end expiratory pressure

References

  1. 1.
    Bernal W, Auzinger G, Dhawan A, Wendon J (2010) Acute liver failure. Lancet 376:190–201CrossRefPubMedGoogle Scholar
  2. 2.
    Ostapowicz G, Fontana RJ, Schiodt FV et al (2002) Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 137:947–954CrossRefPubMedGoogle Scholar
  3. 3.
    Auzinger G, Wendon J (2008) Intensive care management of acute liver failure. Curr Opin Crit Care 14:179–188CrossRefPubMedGoogle Scholar
  4. 4.
    Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RA (2012) Systematic review: acute liver failure – one disease, more than 40 definitions. Aliment Pharmacol Ther 35:1245–1256CrossRefPubMedGoogle Scholar
  5. 5.
    Trey C, Davidson CS (1970) The management of fulminant hepatic failure. Prog Liver Dis 3:282–298PubMedGoogle Scholar
  6. 6.
    O'Grady JG, Schalm SW, Williams R (1993) Acute liver failure: redefining the syndromes. Lancet 342:273–275CrossRefPubMedGoogle Scholar
  7. 7.
    O'Grady JG, Alexander GJ, Hayllar KM, Williams R (1989) Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 97:439–445PubMedGoogle Scholar
  8. 8.
    Lee W, Larson A, Stravitz R (2011) AASLD Position Paper: the management of acute liver failure: update 2011. American Association for the Study of Liver Disease AASLDGoogle Scholar
  9. 9.
    Bernal W, Donaldson N, Wyncoll D, Wendon J (2002) Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet 359:558–563CrossRefPubMedGoogle Scholar
  10. 10.
    Khandelwal N, James LP, Sanders C, Larson AM, Lee WM, Acute Liver Failure Study G (2011) Unrecognized acetaminophen toxicity as a cause of indeterminate acute liver failure. Hepatology 53:567–576CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Paracetamol overdose: Simplification of the use of intravenous acetylcysteine (2012) http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessagesformedicines/CON178225
  12. 12.
    Bernal W, Wendon J (2013) Acute liver failure. N Engl J Med 369:2525–2534CrossRefPubMedGoogle Scholar
  13. 13.
    Rolando N, Wade J, Davalos M, Wendon J, Philpott-Howard J, Williams R (2000) The systemic inflammatory response syndrome in acute liver failure. Hepatology 32:734–739CrossRefPubMedGoogle Scholar
  14. 14.
    Murphy N, Auzinger G, Bernel W, Wendon J (2004) The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure. Hepatology 39:464–470CrossRefPubMedGoogle Scholar
  15. 15.
    Eefsen M, Dethloff T, Frederiksen HJ, Hauerberg J, Hansen BA, Larsen FS (2007) Comparison of terlipressin and noradrenalin on cerebral perfusion, intracranial pressure and cerebral extracellular concentrations of lactate and pyruvate in patients with acute liver failure in need of inotropic support. J Hepatol 47:381–386CrossRefPubMedGoogle Scholar
  16. 16.
    Bernal W, Hall C, Karvellas CJ, Auzinger G, Sizer E, Wendon J (2007) Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure. Hepatology 46:1844–1852CrossRefPubMedGoogle Scholar
  17. 17.
    Kitzberger R, Funk GC, Holzinger U et al (2009) Severity of organ failure is an independent predictor of intracranial hypertension in acute liver failure. Clin Gastroenterol Hepatol 7:1000–1006CrossRefPubMedGoogle Scholar
  18. 18.
    Clemmesen JO, Larsen FS, Kondrup J, Hansen BA, Ott P (1999) Cerebral herniation in patients with acute liver failure is correlated with arterial ammonia concentration. Hepatology 29:648–653CrossRefPubMedGoogle Scholar
  19. 19.
    Strauss G, Hansen BA, Kirkegaard P, Rasmussen A, Hjortrup A, Larsen FS (1997) Liver function, cerebral blood flow autoregulation, and hepatic encephalopathy in fulminant hepatic failure. Hepatology 25:837–839CrossRefPubMedGoogle Scholar
  20. 20.
    Blei AT, Larsen FS (1999) Pathophysiology of cerebral edema in fulminant hepatic failure. J Hepatol 31:771–776CrossRefPubMedGoogle Scholar
  21. 21.
    Birmingham QEH (2011) Guideline. Intracranial hypertension in acute liver failure. Internal Publication, BirminghamGoogle Scholar
  22. 22.
    Keays RT, Alexander GJ, Williams R (1993) The safety and value of extradural intracranial pressure monitors in fulminant hepatic failure. J Hepatol 18:205–209CrossRefPubMedGoogle Scholar
  23. 23.
    Jalan R, Olde Damink SW, Deutz NE, Hayes PC, Lee A (2004) Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension. Gastroenterology 127:1338–1346CrossRefPubMedGoogle Scholar
  24. 24.
    Bachmann R, Bachmann J, Lange J, Nadalin S, Konigsrainer A, Ladurner R (2014) Incidence of heparin-induced thrombocytopenia type II and postoperative recovery of platelet count in liver graft recipients: a retrospective cohort analysis. J Surg Res 186:429–435CrossRefPubMedGoogle Scholar
  25. 25.
    Warkentin TE, Kelton JG (2001) Temporal aspects of heparin-induced thrombocytopenia. N Engl J Med 344:1286–1292CrossRefPubMedGoogle Scholar
  26. 26.
    Racanelli V, Rehermann B (2006) The liver as an immunological organ. Hepatology 43:S54–S62CrossRefPubMedGoogle Scholar
  27. 27.
    Kodakat SGP, Wendon J (2001) Hyperglycemia is associated with intracranial hypertension in patients with acute liver failure. Liver Transpl 7:C21Google Scholar
  28. 28.
    Schutz T, Bechstein WO, Neuhaus P, Lochs H, Plauth M (2004) Clinical practice of nutrition in acute liver failure–a European survey. Clin Nutr 23:975–982CrossRefPubMedGoogle Scholar
  29. 29.
    Plauth M, Cabre E, Riggio O et al (2006) ESPEN guidelines on enteral nutrition: liver disease. Clin Nutr 25:285–294CrossRefPubMedGoogle Scholar
  30. 30.
    Schmidt LE, Dalhoff K (2002) Serum phosphate is an early predictor of outcome in severe acetaminophen-induced hepatotoxicity. Hepatology 36:659–665CrossRefPubMedGoogle Scholar
  31. 31.
    Takahashi H, Koehler RC, Brusilow SW, Traystman RJ (1991) Inhibition of brain glutamine accumulation prevents cerebral edema in hyperammonemic rats. Am J Physiol 261:H825–H829PubMedGoogle Scholar
  32. 32.
    Craig DG, Bates CM, Davidson JS, Martin KG, Hayes PC, Simpson KJ (2012) Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity. Br J Clin Pharmacol 73:285–294CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Schiodt FV, Rochling FA, Casey DL, Lee WM (1997) Acetaminophen toxicity in an urban county hospital. N Engl J Med 337:1112–1117CrossRefPubMedGoogle Scholar
  34. 34.
    Harrison PM, Keays R, Bray GP, Alexander GJ, Williams R (1990) Improved outcome of paracetamol-induced fulminant hepatic failure by late administration of acetylcysteine. Lancet 335:1572–1573CrossRefPubMedGoogle Scholar
  35. 35.
    Green R, Grierson R, Sitar DS, Tenenbein M (2001) How long after drug ingestion is activated charcoal still effective? J Toxicol Clin Toxicol 39:601–605CrossRefPubMedGoogle Scholar
  36. 36.
    Sato RL, Wong JJ, Sumida SM, Marn RY, Enoki NR, Yamamoto LG (2003) Efficacy of superactivated charcoal administered late (3 hours) after acetaminophen overdose. Am J Emerg Med 21:189–191CrossRefPubMedGoogle Scholar
  37. 37.
    Larson AM (2007) Acetaminophen hepatotoxicity. Clin Liver Dis 11:525–548, viCrossRefPubMedGoogle Scholar
  38. 38.
    Lee WM (2003) Drug-induced hepatotoxicity. N Engl J Med 349:474–485CrossRefPubMedGoogle Scholar
  39. 39.
    Rengstorff DS, Osorio RW, Bonacini M (2003) Recovery from severe hepatitis caused by mushroom poisoning without liver transplantation. Clin Gastroenterol Hepatol 1:392–396CrossRefPubMedGoogle Scholar
  40. 40.
    Verleden GM, Vos R, Van Raemdonck DE, Laleman W, Vanaudenaerde BM (2012) Acute liver failure due to Varicella zoster virus infection after lung transplantation: a case report. Transplant Proc 44:1457–1459CrossRefPubMedGoogle Scholar
  41. 41.
    Duran Martinez P, Avila Polo R, Lopez Garcia I, Herruzo Aviles A, Herrera Melero I, Garnacho MJ (2015) Severe acute liver failure due to herpes simplex virus infection in an immunocompetent patient. Med Intensiva 39:191–193. doi: 10.1016/j.medin.2014.04.013, Epub Jul 20CrossRefPubMedGoogle Scholar
  42. 42.
    Berman DH, Leventhal RI, Gavaler JS, Cadoff EM, Van Thiel DH (1991) Clinical differentiation of fulminant Wilsonian hepatitis from other causes of hepatic failure. Gastroenterology 100:1129–1134PubMedGoogle Scholar
  43. 43.
    Korman JD, Volenberg I, Balko J et al (2008) Screening for Wilson disease in acute liver failure: a comparison of currently available diagnostic tests. Hepatology 48:1167–1174CrossRefPubMedGoogle Scholar
  44. 44.
    Guollo F, Narciso-Schiavon JL, Barotto AM, Zannin M, Schiavon LL (2015) Significance of alanine aminotransferase levels in patients admitted for cocaine intoxication. J Clin Gastroenterol 49:250–255. doi: 10.1097/MCG.0000000000000056 CrossRefPubMedGoogle Scholar
  45. 45.
    Muddu AK, Wright M, Sheron N (2006) Ecstasy: an important cause of acute liver failure. Acute Med 5:93–95PubMedGoogle Scholar
  46. 46.
    Maddrey WC, Boitnott JK, Bedine MS, Weber FL Jr, Mezey E, White RI Jr (1978) Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 75:193–199PubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Magill Department of Anaesthesia, Intensive Care Medicine and Pain ManagementChelsea and Westminster HospitalLondonUK

Personalised recommendations