Tag Archives: Liver failure

7/26 Morning Report w/ JLo: Fluctuating Liver Failure of Unclear Etiology

An elderly woman w/ history of recurrent idiopathic colitis and ESRD 2/2 FSGS presents with leukocytosis and liver failure. Liver abnormalities were presumed 2/2 sepsis cholestasis and managed conservatively; she initially improved but then had a rapid decline of hypoglycemia, lactic acidosis, and PEA arrest with worsened LFTs of unclear etiology. Still evolving in the ICU – we don’t have a diagnosis yet but will keep you updated!
*Define Acute Liver Failure: “new liver test abnormalities with impaired synthetic function (INR > 1.5) + encephalopathy developing in
Acute liver injury is a somewhat informal term used when criteria for ALF aren’t met – often if very elevated transaminases without elevated INR or encephalopathy*
Inline image 2

7/21 Morning Report w/ Lenie and Dr. Robbins: AMS in a newly diagnosed cirrhotic

A middle aged man w/ HCV and excessive etoh use presents with altered mental status, found to have liver failure of unclear chronicity. Already growing GNRs in blood!
*The evidence behind pharmacologic treatments for alcoholic hepatitis is shotty; a 2015 NEJM paper showed that prednisone showed trends of decreased mortality at 28 days that did not reach significance. Prednisone should not be given in the setting of suspected infection. Pentoxifylline does not improve survival. http://www.nejm.org/doi/10.1056/NEJMoa1412278