Clinical manifestations-acute liver failure

• Initial presentation: N/V, malaise, RUQ pain, jaundice, encephalopathy, multiorgan failure

• Neurologic: 👉 hepatic encephalopathy:

• cerebral edema: astrocyte swelling related in part to → ↑ ammonia levels

• Cardiovascular: hypotension with low SVR, shock

• Pulmonary: respiratory alkalosis, impaired peripheral O2 uptake, pulm edema, ARDS

• GI: GI tract bleed common (need PPI Ppx), pancreatitis (due to → ischemia, drugs, infxn)

• Renal:

  • ATN,
  • hepatorenal syndrome,
  • hyponatremia,
  • hypokalemia,
  • hypophosphatemia

• Hematology:

  • bleeding diathesis w/ thrombocytopenia,
  • ↑ PT/PTT,
  • ↓ fibrinogen,
  • ↓ synthesis of coag factors balanced by ↓ protein C/S; bleeding mostly due to → low platelet count,
  • DIC

• Infection:

  • espec. with Staph,
  • Strep,
  • GNRs,
  • fungi (↓ immune fxn, invasive procedures);
  • fever and ↑ WBC may be absent,
    • most common sites are respiratory,
    • urinary &
    • blood

• Endocrine:

  • hypoglycemia (↓ glc synthesis),
  • metabolic acidosis (↑ lactate),
  • adrenal insuf.