Hepatic Encephalopathy Case Study

- MANAGEMENT OF ACUTE SEVERE TOXICITY (MDX): Patients who present more than 36 hours (“late”) after acute acetaminophen ingestion may have significant liver injury and even liver failure (INR greater than 1.5, acidosis or encephalopathy). Intubate patients with altered mental status and resuscitate hypotensive patients with crystalloid and adrenergic vasopressors. Treat coagulopathic patients who are bleeding with fresh frozen plasma. Patients with renal failure may require renal replacement therapy. Administer intravenous acetylcysteine to all patients with liver injury. Patients with hepatic encephalopathy, acidosis or significant coagulopathy (INR greater than 5) should be evaluated for liver transplantation. Patients who present early following …show more content…
>18 hours post-ingestion).
- AIRWAY MANAGEMENT (MDX): Perform aggressive airway protection in patients with signs of encephalopathy or CNS depression if concomitant drugs like opioids are ingested.
- ANTIDOTE: NAC (MDX): Acetylcysteine should be administered to any patient at risk for hepatic injury (either serum acetaminophen concentration above the possible toxicity line on the Rumack-Matthew Nomogram, or history of ingesting more than 200 mg/kg or 10 g [whichever is less] and serum concentration not available or time of ingestion not known), and to patients who have hepatic injury and a history of acetaminophen overdose. Both therapeutic serum concentrations of N-acetylcysteine and high concentrations of acetaminophen can elevate the INR. These elevations are usually mild (INR should not be greater than 1.5), occur between 4 and 20 hours post ingestion, and resolve as treatment is continued (UTD). If a patient vomits within 60 minutes of an oral dose of N-acetylcysteine, the dose should be repeated. Persistent vomiting in spite of antiemetic therapy is an indication to administer N-acetylcysteine intravenously