Initial laboratory analysisProthrombin time/INR
Complete blood count
Chemistries
Liver function test: AST, ALT, alkaline phosphatase, GGT, total bilirubin, albumin
Creatinine, urea/blood urea nitrogen, sodium, potassium, chloride, bicarbonate, calcium, magnesium, phosphate
Glucose
Amylase and lipase
Arterial blood gas, lactate
Blood type and screen
Paracetamol (acetaminophen) level, toxicology screen
Viral hepatitis serologies: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HCV
Autoimmune markers: ANA, ASMA, LKMA, immunoglobulin levels
Ceruloplasmin level (when Wilsons disease suspected)
Pregnancy test (females)
Ammonia (arterial if possible)
HIV status (has implication for transplantation)History taking should include a careful review of possible exposures to viral infection and drugs or other toxins. From history and clinical examination, the possibility of underlying chronic disease should be ruled out as it may require different management. A liver biopsy done via the transjugular route because of coagulopathy is not usually necessary, other than in occasional malignancies. As the evaluation continues, several important decisions have to be made; such as whether to admit the patient to an ICU, or whether to transfer the patient to a transplant facility. Consultation with the transplant center as early as possible is critical due to the possibility of rapid progression of ALF.
Trey and Davidson introduced the phrase fulminant hepatic failure in 1970, which they described as a "... potentially reversible condition, the consequence of severe liver injury, with an onset of encephalopathy within 8 weeks of the appearance of the first symptoms and in the absence of pre-existing liver disease". Later, it was suggested that the term fulminant should be confined to patients who develop jaundice to encephalopathy within 2 weeks. Phrases subfulminant hepatic failure and late onset hepatic failure were coined for onset between 2 weeks to 3 months and for 8 weeks to 24 weeks, respectively. The umbrella phrase of acute liver failure was proposed by Kings College group, which has been adopted in this article. Paradoxically, in this classification, the best prognosis is in the hyperacute group. References
External links
Fulminant Hepatic Failure at eMedicine