Case of the Month #16 - cerebral oedema

Published 02/02/2022

How should this patient be managed?

  • Correction of the coagulopathy is not advised as this effects Kings College Criteria which is used to determine which patients with fulminant liver failure should be offered transplantation.
  • Central line therefore inserted without coagulation factors and patient started on noradrenaline +/- vasopressin
  • Patient should be referred and transferred to the Regional Liver Unit

On arrival at the Regional Liver ICU the following parameters are seen: BP 90/60 (noradrenaline 0.5μg/kg/min), pH 7.22, BE – 8, Lactate 12, Na 132 mmol/L, INR 10, blood glucose 2 mmol/L. The patient is commenced on 50% dextrose to normalise blood glucose. Hypotonic glucose solutions are avoided to prevent hyponatraemia in patients at risk of cerebral oedema.