Acute Liver Failure

Administration of N-acetylcysteine to all patients with ALF regardless of its etiology may become standard-of-care - R. Todd Stravitz

Acute Liver Failure

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HWN Suggests

Critical Care Alert: Role of N-Acetylcysteine in Non-acetaminophen-related Acute Liver Failure

NAC is well known to emergency medicine physicians as the antidote in acute acetaminophen ingestion. The scope of use for this medication beyond that is often not considered, such as in other etiologies of acute liver failure like viral hepatitis, infection, autoimmune, etc. As demonstrated by this meta-analysis, the data is difficult to come by, however, as more comes to light, the signal within suggests NAC has more to offer than just an antidote to acute liver failure in the setting of acetaminophen overdose.

Other causes of acute liver failure are inevitably going to present in the emergency department and acknowledging that NAC likely has a place in the care of these patients is…

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 Critical Care Alert: Role of N-Acetylcysteine in Non-acetaminophen-related Acute Liver Failure

Given the grave sequelae of ALF, an updated investigation into whether the use of NAC can be utilized as an adjunct treatment in patients with NAALF was warranted. The study... provides evidence that suggests an overall improved survival rate with NAC in NAALF patients.

Anesthesia Key

The underlying cause of liver failure and the grade of the encephalopathy at time of presentation are critical determinants of outcome.

Critical Care in Emergency Medicine

Patients with acute liver failure can be incredibly sick and have an exceedingly high mortality. Early identification and prompt, evidence-based management of the patient with acute liver failure may improve patient-centered outcomes. In this podcast, we discuss updated guidelines for the management of adult patients with acute liver failure.


Very rapid progress (time jaundice to encephalopathy < 8 days) relatively better prognosis (if no cerebral oedema)


Acute liver failure is less common than chronic liver failure, which develops more slowly. Acute liver failure, also known as fulminant hepatic failure, can cause serious complications, including excessive bleeding and increasing pressure in the brain. It's a medical emergency that requires hospitalization. Depending on the cause, acute liver failure can sometimes be reversed with treatment. In many situations, though, a liver transplant may be the only cure.

Mount Sinai Intensive Board Review in Gastroenterology & Hepatology

During this 20-25 minute pre-recorded lecture, Dr. James F. Crismale discusses the topic of acute liver failure. This in-depth review will provide an update on this topic for your clinical practice as well as supplement your learning for the ABIM Gastroenterology and Hepatology boards.


Fulminant hepatic failure (FHF) occurs when the failure takes place within eight weeks of the onset of the underlying illness. •Late-onset hepatic failure (also called subacute FHF) occurs when there has been a gap of 8 to 26 weeks. The difference may not immediately be obvious, as the underlying disease may have been present for a long time but undiagnosed. •Chronic decompensated hepatic failure occurs when the latent period is over six months.

UMEM Educational Pearls

Acute liver failure is defined as new and rapidly evolving hepatic dysfunction associated with neurologic dysfunction and coagulopathy (INR >1.5). Most common cause of death in these patients are multiorgan failure and sepsis. Drug-induced liver injuy most common cause in US, with viral hepatitis most common cause worldwide.

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