What Is the Initial Treatment of Acute Liver Failure?
Acute liver failure demands immediate, structured supportive intervention. Rapid haemodynamic instability, dysglycaemia, and the risk of encephalopathy require protocol-driven management from the outset.
Clinical Context
This protocol covers the initial phase of acute liver failure, where hepatic dysfunction leads to systemic compromise. Key concerns include circulatory instability, abnormal glucose regulation, risk of encephalopathy, and impaired ability to maintain adequate nutrition.
Treatment Approach
Initial care centres on targeted intravenous support and specific metabolic interventions; additional measures address complications in selected patients based on their clinical status.
Key Clinical Goal
Maintain blood glucose in the range of 150–180 mg/dL.
References
DOI: 10.14309/ajg.0000000000002340
- In patients with ALF and hypotension, intravenous fluid resuscitation should be initiated.
- For hypoglycemia, a constant infusion of dextrose 10% solution should be used to maintain blood sugar level in the range of 150-180 mg/dL.
- In patients with ALF and grade 2 or higher encephalopathy, we suggest early CRRT for the management of hyperammonemia even in the absence of conventional RRT indications.
- In patients with ALF, enteral nutritional support should be started if the patient is unable to resume oral intake within 5-7 days.