Management of acute liver failure
| Transfer the patient to the intensive care unit in a tertiary care center with facilities for liver transplant |
| Neurologic complications |
| Grade 2–3 encephalopathy: order computed tomography of the brain to rule out secondary causes of encephalopathy; avoid hyponatremia and use of sedatives |
| Grade 3–4 encephalopathy: intubate; elevate the head end of bed to 30 degrees; consider giving mannitol or hypertonic saline |
| Infectious complications |
| Give a broad-spectrum antibiotic if infection is suspected, and add an antifungal agent if there is no improvement with initial antibiotic coverage |
| Gastrointestinal complications |
| Give a histamine H2 receptor blocker or a proton pump inhibitor to prevent upper gastrointestinal bleeding |
| Determining the cause of acute liver failure |
| Obtain a thorough history of ingestion of drugs from the patient and family |
| Laboratory testing, including toxicology screen, acetaminophen or acetaminophen-protein adduct levels; serologic testing for hepatitis A, hepatitis B, hepatitis C, herpes simplex virus, autoimmune hepatitis, and serum and urine copper and serum ceruloplasmin levels |