Major Complications of Acute Liver Failure and Their Management
| Complication | Management |
|---|---|
| Cerebral oedema | See text |
| Hypotension | Correct hypovolaemia with blood or 4.5% human albumin solution Use epinephrine, norepinephrine or dopamine infusion (P. 13 Table 2.7) to maintain mean arterial pressure >60 mmHg |
| Acute kidney injury | Correct hypovolemia Avoid high-dose furosemide See Appendix 77.1 Hepatorenal syndrome Start renal replacement therapy if anuric or oliguric with plasma creatinine >400μmol/L |
| Hypoglycaemia | Give glucose 10% IV 1L 12-hourly to prevent hypoglycaemia Check blood glucose 1–4 hourly If blood glucose is <4.0 mmol/L, give 100 mL of 20% glucose or 200 mL of 10% glucose over 15–30 min IV; recheck blood glucose after 10 min, if still <4.0 mmol/L, repeat |
| Coagulopathy | Give vitamin K 10 mg IV daily Give platelet transfusion if count <50×109/L Give fresh frozen plasma only if there is active bleeding |
| Gastric stress ulceration | Prophylaxis with proton pump inhibitor, ranitidine or sucralfate |
| Hypoxaemia | Many possible causes: inhalation, infection, pulmonary oedema, atelectasis, intrapulmonary haemorrhage. Increase inspired oxygen Ventilate with positive end-expiratory pressure if SaO2 remains <92% |
| Sepsis | Daily culture of blood, sputum and urine Early treatment of presumed infection with broad-spectrum antibiotic therapy: discuss with microbiologist Consider antifungal therapy if fever with negative blood cultures |