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Acute Hepatitis and Acute Liver Failure

  • Ddx

    • viral, EtOH, drugs (acetaminophen)
  • Acute liver failure criteria

    • encephalopathy
    • INR >= 1.5
    • no preexisting cirrhosis
    • duration < 26 weeks
  • Admission orders

    • Admit: ICU
    • Diagnosis: Acute Hepatitis and Acute Liver Failure
    • Condition: Guarded
    • Vital Signs: Routine
    • Allergies:
    • Nursing: Guaiac stools, capillary glc qid and for AMS
    • Diet: NPO; Advance Diet as Tolerated
    • Activity: As Tolerated
    • Labs:
      • CBC, Chem, LFTs, INR qday
      • Hepatitis A, B, and C serologies
      • EtOH level
      • acetaminophen level
      • long toxicology screen
    • IV: NS 200 mL/h for 2 Liters, then D5 1/2 NS at 100 mL/h for Maintenance
    • Special: consult GI, transplant hepatology
    • Medications:
      • Metoclopramide (Reglan) 10 mg IV/PO q 4-6 hours prn
      • Lactulose 15 mL PO tid - increase to achieve 3-5 loose stools per day
      • Avoid sedatives and narcotics
    • Call HO: temperature > 38.5 C, SBP < 100 mmHg, HR > 100 bpm, and any evidence of sedation or altered mental status
  • Discharge

    • criteria: ambulating, improving LFTs, normal mental status, tolerating PO
    • f/u 1-2 weeks

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