Acute liver failure is rare, but when it does occur it requires an organized diagnostic and therapeutic approach. Success often relies upon aggressive support of other organs (e.g. renal failure and management of intracranial hypertension).
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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I agree with NAC for all ALF of unclear etiology but I am not sure in ischemic ALF from cardiogenic shock or after prolonged CPR… what is your approach to this?
hypoxic hepatitis is a different disease entity. you have to treat the underlying problem.
Also even for the practice of NAC for all cause ALF the literature doesn´t uniformely prove benefit.
Then one could argue…but why not give it anyway? it´s a harmless drug.- It´s not. Allergic reactions are one thing. Also there has been animal data, that it prolongs liver recovery. In a pediatric study the group receiving NAC had better transplant free survival. It seems to also have antiinflammatory effects, that might sometimes be undesirable.
so short answer: i wouldn´t give it.
I agree with you but I see it being given for ischemic ALF here and there so wanted to check where others stand.
What about TPE ? https://www.wjgnet.com/1007-9327/full/v26/i2/219.htm
As opposed to the other “liver assist devices” (MARS, Prometheus etc) it seems to have some benefit. There was only one RCT. That trial showed better survival. It is recommended by the EASL (European Association for the Study of the Liver).