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Acute-On-Chronic Liver Failure
- Acute-on-chronic liver failure (ACLF) is defined as an acute deterioration of liver function in a patient with cirrhosis that is associated with organ failure and has high short-term mortality.
- Key extrahepatic organ failures in ACLF include the renal, CNS, respiratory, circulatory, and coagulation systems.
- With respect to CNS failure in ACLF:
- Hepatic encephalopathy (HE) is the most common manifestation
- A normal ammonia level makes HE unlikely
- Benzodiazepines should be avoided
- Primary triggers for HE include infection, GIB, and aggressive diuresis
- Treatment of HE primarily consists of lactulose and rifaximin
References
Perricone G, et al. Intensive care management of acute-on-chronic liver failure. Critical Care. 2023;49:903-21.