Case of the Month #26 - liver failure

Published 10/02/2022

What are the clinical features of fulminant liver failure?

  • Encephalopathy and brain edema: due to accumulation of toxic metabolites such as ammonia; frequent examination of pupillary size and reactivity is essential.
  • Coagulopathy: severe impairment in coagulation factors and their inhibitors as well as platelet dysfunction.
  • Renal failure: either by direct paracetamol toxicity or from hepatorenal syndrome.
  • Metabolic derangements: hyponatremia, hypoglycemia, hypokalemia, persistent acidosis. 
  • Sepsis and high inflammatory response: bacterial and fungal infections are common due to impaired immunity.
  • Hyperdynamic circulation and vasodilatory shock.