A 48-year-old man on ICU has acute liver failure from drug-induced hepatotoxicity. He develops grade 3 hepatic encephalopathy (somnolent but rousable,...

Question

A 48-year-old man on ICU has acute liver failure from drug-induced hepatotoxicity. He develops grade 3 hepatic encephalopathy (somnolent but rousable, confused, marked asterixis). His ammonia level is 180 µmol/L (normal

Accepted Answer

IV N-acetylcysteine, lactulose via nasogastric tube, avoidance of sedatives, and consideration of intubation for airway protection

Answer

Oral lactulose 30 mL TDS and oral rifaximin 550 mg BD

Answer

IV flumazenil as a specific reversal agent

Answer

Oral neomycin 1 g QDS

Answer

High-protein enteral feed to reverse catabolism

uk-fficm MCQ (SBA): Acute Liver Failure

A 48-year-old man on ICU has acute liver failure from drug-induced hepatotoxicity. He develops grade 3 hepatic encephalopathy (somnolent but rousable, confused, marked asterixis). His ammonia level is 180 µmol/L (normal <50). What is the most appropriate management of the hepatic encephalopathy?