Internal Medicine

acute liver failure

Q: What is the INR threshold that defines coagulopathy in acute liver failure?

According to the summary, coagulopathy in acute liver failure is defined as INR ≥ 1.5. This is one of the key diagnostic criteria along with acute onset of jaundice and hepatic encephalopathy.

Q: What is the most common cause of acute liver failure in high-income countries?

The summary clearly states that paracetamol (acetaminophen) toxicity is the most common cause of acute liver failure in high-income countries. This is in contrast to low- and middle-income countries where viral hepatitis B is more prevalent.

Q: Within what timeframe must symptoms occur to be classified as acute liver failure?

According to the summary, acute liver failure is characterized by rapid deterioration of liver function occurring within < 26 weeks of symptom onset in a patient without pre-existing liver disease.

Q: What is the characteristic clinical finding in Grade 2 hepatic encephalopathy?

The summary indicates that Grade 2 hepatic encephalopathy is characterized by asterixis, lethargy, disorientation to time, and personality change. Asterixis (flapping tremor) is a hallmark finding at this stage.

Q: What is the first-line drug for management of hepatic encephalopathy?

According to the summary, lactulose is the first-line treatment for hepatic encephalopathy. The dose is 30-45 mL orally 2-4 times daily, titrated to achieve 2-3 soft stools per day.

Acute liver failure is a rapid deterioration of liver function occurring within 26 weeks in a patient without pre-existing liver disease, characterized by jaundice, coagulopathy with INR ≥ 1.5, and hepatic encephalopathy. This condition is clinically significant because it can progress rapidly from subtle neuropsychiatric changes like reversed sleep rhythm to coma, while simultaneously causing life-threatening complications including cerebral edema, coagulopathy with bleeding, and hypoglycemia. Medical students must recognize that the causes vary by geographic setting—with acetaminophen toxicity predominating in high-income countries and viral hepatitis B being more common in low- and middle-income regions—and that early identification of the underlying cause is essential because specific treatments like N-acetylcysteine for acetaminophen overdose can be lifesaving.

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1. What is the INR threshold that defines coagulopathy in acute liver failure?

2. What is the most common cause of acute liver failure in high-income countries?

3. Within what timeframe must symptoms occur to be classified as acute liver failure?

4. What is the characteristic clinical finding in Grade 2 hepatic encephalopathy?

5. What is the first-line drug for management of hepatic encephalopathy?

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acute liver failure

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