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Gastroenterol Hepatol (N Y). 2012 Mar;8(3):161-212.

Acute liver failure in adults: an evidence-based management protocol for clinicians.

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Division of Gastroenterology, University of California (UC) San Diego School of Medicine, San Diego, California, USA.


With the goal of providing guidance on the provision of optimal intensive care to adult patients with acute liver failure (ALF), this paper defines ALF and describes a protocol for appropriately diagnosing this relatively rare clinical entity and ascertaining its etiology, where possible. This paper also identifies the few known therapies that may be effective for specific causes of ALF and provides a comprehensive approach for anticipating, identifying, and managing complications. Finally, one of the more important aspects of care for patients with ALF is the determination of prognosis and, specifically, the need for liver transplantation. Prognostic tools are provided to help guide the clinician in this critical decision process. Management of patients with ALF is complex and challenging, even in centers where staff members have high levels of expertise and substantial experience. This evidence-based protocol may, therefore, assist in the delivery of optimal care to this critically ill patient population and may substantially increase the likelihood of positive outcomes.


Acute liver failure; acute-on-chronic liver failure; coagulopathy; fulminant liver failure; hepatic encephalopathy; intracranial hypertension; liver transplantation


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