Dr. William Hutson is a Professor of Medicine and the Director of Hepatology/Liver Transplatation at the University of Maryland. Â 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. Â If you aren’t quite sure what just happened, take a listen to Dr. Hutson below.
MarylandCCProject- Hutson – Acute Liver Failure.mp3
Pearls
- Drug induced liver injury (DILI) is the most common cause of ALF in the Western world. Â Acetaminophen (APAP) is the most common cause, often unintentional from drugs that have APAP combined with them.
- The safe dose of APAP has recently been changed from 4 grams per day down to 3 grams daily – MAX.
- Encephalopathy caused by cerebral edema accounts for 20-25% of deaths as a result of acute liver failure.
- 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.
- Consider therapeutic hypothermia in patients with ALF. Â 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.
