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J Crit Care. 2013 Oct;28(5):783-91. doi: 10.1016/j.jcrc.2013.04.002. Epub 2013 May 15.

Assessment and management of cerebral edema and intracranial hypertension in acute liver failure.

Author information

  • 1Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA. Electronic address: vahid.mohsenin@yale.edu.

Abstract

Acute liver failure is uncommon but not a rare complication of liver injury. It can happen after ingestion of acetaminophen and exposure to toxins and hepatitis viruses. The defining clinical symptoms are coagulopathy and encephalopathy occurring within days or weeks of the primary insult in patients without preexisting liver injury. Acute liver failure is often complicated by multiorgan failure and sepsis. The most life-threatening complications are sepsis, multiorgan failure, and brain edema. The clinical signs of increased intracranial pressure (ICP) are nonspecific except for neurologic deficits in impending brain stem herniation. Computed tomography of the brain is not sensitive enough in gauging intracranial hypertension or ruling out brain edema. Intracranial pressure monitoring, transcranial Doppler, and jugular venous oximetry provide valuable information for monitoring ICP and guiding therapeutic measures in patients with encephalopathy grade III or IV. Osmotic therapy using hypertonic saline and mannitol, therapeutic hypothermia, and propofol sedation are shown to improve ICPs and stabilize the patient for liver transplantation. In this article, diagnosis and management of hepatic encephalopathy and cerebral edema in patients with acute liver failure are reviewed.

KEYWORDS:

Acute liver failure; Brain edema; Hepatic encephalopathy

PMID:
23683564
DOI:
10.1016/j.jcrc.2013.04.002
[PubMed - indexed for MEDLINE]
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