Hepatic failure

Gunning, Kevin

doi:10.1016/j.mpaic.2008.12.002

« Previous Next »Anaesthesia & intensive care medicine
Volume 10, Issue 3 , Pages 124-126, March 2009

Hepatic failure

Kevin Gunning, FRCS, FRCA, qualified from St Bartholomew's Hospital and trained in surgery and anaesthesia in London and Geneva. He is a consultant in anaesthesia and intensive care at Addenbrooke's Hospital Cambridge and Director of the John Farman ICU. His interests include sedation and training in intensive care. He is a member of the ICS Council and past chairman of the Regional Advisors in ICM. Conflicts of interest: none declared

Abstract

Acute liver failure is characterized by coagulopathy and encephalopathy in patients with previously normal liver function and an illness of less than 26 weeks’ duration. It leads to multiple organ failure and has a high mortality. The main causes are acetaminophen overdose, idiosyncratic drug reactions and viral hepatitis. Patients deteriorate rapidly and early referral to a liver transplant centre for those patients with indicators of a poor prognosis, such as pH < 7.3 in patients after an overdose of acetaminophen, is essential. Intubation before transfer is mandatory for patients with level III or IV encephalopathy and should be considered for patients with level II encephalopathy. Treatment is directed at support of the circulation and failing organs and control of cerebral oedema. Liver transplantation is the only treatment to improve mortality with survival rates of 75–80%. Death is due to cerebral oedema and multiple organ failure.

Keywords: acute liver failure, cerebral oedema, coagulopathy, liver transplantation, multiple organ failure