Idiosyncratic Drug-induced Acute Liver Failure in Adults with Encephalopathy or Coagulopathy

Clinical Scenario

This protocol addresses adults who develop idiosyncratic drug-induced acute liver failure (ALF) and present with signs of severe hepatic decompensation — specifically encephalopathy and/or coagulopathy at coma grade I–II.

Patient Population

Adults presenting with encephalopathy or biochemical evidence of coagulopathy indicating ALF generally require hospitalisation. Early identification of coma grade and hepatic synthetic failure is critical to initiating the appropriate clinical pathway without delay.

Treatment Approach (Partial Overview)

In this setting, liver transplantation is considered as a therapeutic option for eligible patients. The complete structured protocol — including patient selection criteria, timing, and the full management pathway — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jhep.2019.02.014

Adults with idiosyncratic drug-induced ALF should receive NAC early in the course (coma grade I-II).

Patients with signs or biochemical indication of ALF such as encephalopathy and/or coagulopathy should generally be hospitalized.

In case of drug-induced ALF, liver transplantation should be considered as a therapeutic option.

Liver transplantation is still the primary rescue treatment for ALF, with a 1-year survival rate of around 80% in liver transplant recipients with ALF.

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