Cause:Multiple etiologies result in end-stage hepatic failure, which has 4 major complications: ascites, hemorrhage, renal failure, and encephalopathy
Pathophys:Decr SVR due to incr vasodilators, especially in splancnic circulation from liver diesease
Sx:of renal failure (Renal Stones)
20% of patients with hepatic failure die from renal failure
of renal failure (Renal Stones)
Lab: Chem:Elevated BUN and creatinine; low urinary Na
Rx:
Supportive care including dialysis
Vasoconstrictors:
- 1st: Terlipressin 0.5-2 mg iv q4-12h
- 2nd: Midodrine 7.5-12.5 mg po tid w octreotide 100-200 mgm sc tiw
- 3rd: norepinephrine
Albumin 1 gm/kg iv day 1 then 20-40 gm iv qd
Transplant