Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Fulminant Hepatic Failure 595

■King’s College prognostic indicators indicate patients who will have

a mortality >90% and should be listed for transplant FHF secondary

to acetaminophen overdose

■pH <7.30, or

■INR >6.5 and serum creatinine >3.4 mg/dL in patients with grade III

or IV encephalopathy

FHF secondary to other causes

■INR >6.5, or any 3 of the following variables:

■etiology non-A, non-B hepatitis or drug reaction

■age <10 and >40 years

■duration of jaundice before encephalopathy >7 days

■serum bilirubin >17.6 mg/dL

■INR >3.5

follow-up

■Daily monitoring during acute event

■Outpatient monitoring if liver disease begins to resolve

➣clinical assessment

➣liver tests

complications and prognosis

Complications

■Encephalopathy – risk of multi-organ failure and death is highest

■Cerebral edema – most common cause of death

■Renal failure

■Metabolic disorders:

➣Hypoglycemia

➣Acidosis

➣Alkalosis

➣Hypoxemia

■Coagulopathy

■Infections

Prognosis

■Better with a more rapid onset of encephalopathy; one series showed

survival of 36% in patients with encephalopathy within 1 week of the

onset of jaundice, and 14% in the remainder