Multiprofessional Critical Care Review: Adult 2024 (MCCRCA24ON)-Hepatic Failure

Video Transcription

Video Summary

In this session on hepatic failure, a detailed case of a 36-year-old male with acute fulminant viral hepatitis is discussed. The patient, who recently returned from Haiti, developed severe symptoms including elevated liver enzymes, worsening mental status, and renal failure. Treatment included ICU admission, intubation, norepinephrine, and vasopressin. It's emphasized that N-acetylcysteine should be used along with conservative therapy for acute fulminant viral hepatitis, due to its benefits in improving transplant-free survival. Further, the importance of renal replacement therapy, particularly CVVH, for managing hyperammonemia is highlighted. Also discussed are hepatorenal syndrome and its treatment with vasoconstrictors, particularly in the context of advanced liver disease, and the differential diagnoses and treatments for portopulmonary hypertension and hepatopulmonary syndrome. The approach and management strategies for these conditions in liver transplant candidates are explored in detail.

Keywords

hepatic failure

acute fulminant viral hepatitis

N-acetylcysteine

renal replacement therapy

hepatorenal syndrome

liver transplant

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