Acute Liver Failure

Dr. William Hutson is a Professor of Medicine and the Director of Hepatology/Liver Transplatation at the University of Maryland.  In this core content lecture, Dr. Hutson discusses the causes, work-up, and treatment of acute liver failure (ALF). The world of hepatology seems to have more acronyms than the military – but after this lecture, the next time you see a 32 y/o male with acute HBV and possible APAP toxicity, you will be able to nail the diagnosis of ALF, treat with NAC, discuss OLT, and consider MARS therapy to bridge.  If you aren’t quite sure what just happened, take a listen to Dr. Hutson below.

MarylandCCProject- Hutson – Acute Liver Failure.mp3


  1. Drug induced liver injury (DILI) is the most common cause of ALF in the Western world.  Acetaminophen (APAP) is the most common cause, often unintentional from drugs that have APAP combined with them.
  2. The safe dose of APAP has recently been changed from 4 grams per day down to 3 grams daily – MAX.
  3. Encephalopathy caused by cerebral edema accounts for 20-25% of deaths as a result of acute liver failure.
  4. Lactulose decreases ammonia levels by changing the pH of the colon to convert ammonia to ammonium.  This decreases the absorption of the cerebral-toxic ammonia.
  5. Consider therapeutic hypothermia in patients with ALF.  Target temperatures of 32-34 degrees celsius can decrease cerebral uptake of ammonia, cerebral edema, and intracranial hypertension.

BONUS Pearl: Give NAC – just give it.


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