LiverBOMB! A Deep Dive into Liver Failure

We are joined once again by Michael Griggs PharmD, Dr. Taylor Wachs, and Will Appleby to discuss liver failure and its management and complications. We discuss everything from resuscitation management, pharmacology of course, and what are we really mitigating here. 

Definition ALF - INR>1.5 with hepatic encephalopathy and no underlying cirrhosis

AST - Liver, cardiac, skeletal, kidney, brain, pancreas

ALT - SPECIFIC to liver damage

AST/ALT Ratio = 1 = Ischemia

AST/ALT Ratio > 2.5 = Alcoholism

AST/ALT Ratio < 1 = Viral, Ischemia, Toxic

HRS = Hepatorenal Syndrome

 

NAC (Mucomyst)

Tylenol Dosing - 150mg/kg over 1 hour, 50 mg/kg over 4 hour

ALF mitigating transplant - 150mg/kg over 15 min, 12.5mg/kg/hr for 4 hours then 6.25 mg/kg/hr for 72 hours