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Critical Care183 papers

Hepatic failure

Last edited: 4/14/2026

Overview

Hepatic failure encompasses severe impairment of liver function, often leading to encephalopathy and multiorgan failure. It can be acute (fulminant) or develop over time, with various etiologies including viral hepatitis, drug-induced injury, and metabolic disorders. 5711161718

Diagnosis

  • Clinical Presentation: Encephalopathy, jaundice, ascites, coagulopathy, and elevated transaminases. 51114
  • Laboratory Tests: Elevated liver enzymes (ALT, AST), prolonged PT/INR, hypoalbuminemia, hyperbilirubinemia. 51114
  • Imaging: Abdominal ultrasound to assess liver morphology and rule out other causes. 5
  • Prognostic Indicators: Serum Gc-globulin levels may predict multiple organ failure. 13
  • Specific Etiologies: Viral markers (HCV, HBV), drug history, metabolic screening. 515161718

    • Management

  • Supportive Care: Intensive care unit (ICU) management, mechanical ventilation, fluid and electrolyte balance. 16
  • Metabolic Support: Lactulose for encephalopathy, nutritional support tailored to patient needs. 514
  • Specific Treatments: Liver transplantation for irreversible cases; specific antidotes for drug-induced liver injury (e.g., N-acetylcysteine for acetaminophen toxicity, though not explicitly mentioned in abstracts). 71012
  • Toxin Removal: Bioartificial liver assist devices under investigation for severe cases. 9
  • Monitoring: Close monitoring of coagulation status, fluid balance, and neurological function. 514

    • Special Populations

  • Pediatrics: Thorough history and physical examination crucial; consider underlying gastrointestinal disorders contributing to failure to thrive (FTT). 1220
  • Drug-Induced Cases: Increased vigilance in patients on hepatotoxic medications (e.g., tipranavir, bicalutamide, minocycline, sulfamethoxazole-trimethoprim). 610121718

    • Key Recommendations

  • Initiate ICU management with close monitoring of metabolic and neurological status in fulminant hepatic failure. (Evidence: Strong 514)
  • Consider liver transplantation for patients with irreversible liver failure and no contraindications. (Evidence: Strong 7)
  • Evaluate serum Gc-globulin levels to assess risk of multiple organ failure in fulminant hepatic failure patients. (Evidence: Moderate 13)
  • Conduct a detailed history and physical examination in pediatric patients presenting with failure to thrive to identify underlying causes. (Evidence: Moderate 1220)
  • Exercise caution with known hepatotoxic drugs and monitor liver function tests regularly in susceptible patients. (Evidence: Expert opinion)

    • References

    1 Calleo V, Surujdeo R, Thabet A. Emergency department management of patients with failure to thrive. Pediatric emergency medicine practice 2020. link 2 Larson-Nath CM, Goday PS. Failure to Thrive: A Prospective Study in a Pediatric Gastroenterology Clinic. Journal of pediatric gastroenterology and nutrition 2016. link 3 Maleux G, Bergans N, Bosmans H, Bogaerts R. RADIATION PROTECTION CABIN FOR CATHETER-DIRECTED LIVER INTERVENTIONS: OPERATOR DOSE ASSESSMENT. Radiation protection dosimetry 2016. link 4 Eldeen FZ, Lee CF, Lee CS, Chan KM, Lee WC. "Passing loop" technique: a new modification of the piggyback technique tailored to voluminous liver grafts--case report. Transplantation proceedings 2013. link 5 García-Martínez R, Simón-Talero M, Córdoba J. Prognostic assessment in patients with hepatic encephalopathy. Disease markers 2011. link 6 Chan-Tack KM, Struble KA, Birnkrant DB. Intracranial hemorrhage and liver-associated deaths associated with tipranavir/ritonavir: review of cases from the FDA's Adverse Event Reporting System. AIDS patient care and STDs 2008. link 7 Gotthardt D, Riediger C, Weiss KH, Encke J, Schemmer P, Schmidt J et al.. Fulminant hepatic failure: etiology and indications for liver transplantation. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 2007. link 8 Locklin M. The redefinition of failure to thrive from a case study perspective. Pediatric nursing 2005. link 9 Shi Q. On bioartificial liver assist system: theoretical exploration and strategies for further development. Artificial cells, blood substitutes, and immobilization biotechnology 2000. link 10 Hunter EB, Johnston PE, Tanner G, Pinson CW, Awad JA. Bromfenac (Duract)-associated hepatic failure requiring liver transplantation. The American journal of gastroenterology 1999. link 11 Bernstein D, Tripodi J. Fulminant hepatic failure. Critical care clinics 1998. link70391-2) 12 Dawson LA, Chow E, Morton G. Fulminant hepatic failure associated with bicalutamide. Urology 1997. link00355-X) 13 Schiødt FV, Ott P, Bondesen S, Tygstrup N. Reduced serum Gc-globulin concentrations in patients with fulminant hepatic failure: association with multiple organ failure. Critical care medicine 1997. link 14 Atillasoy E, Berk PD. Fulminant hepatic failure: pathophysiology, treatment, and survival. Annual review of medicine 1995. link 15 Zhang DF, Ren H, Jia XP, Zhou YS. Serum tumor necrosis factor (TNF) in the pathogenesis of clinical hepatic failure of HCV and/or HBV infection. Chinese medical journal 1993. link 16 Kelso LA. Fluid and electrolyte disturbances in hepatic failure. AACN clinical issues in critical care nursing 1992. link 17 Min DI, Burke PA, Lewis WD, Jenkins RL. Acute hepatic failure associated with oral minocycline: a case report. Pharmacotherapy 1992. link 18 Ransohoff DF, Jacobs G. Terminal hepatic failure following a small dose of sulfamethoxazole-trimethoprim. Gastroenterology 1981. link 19 Trobe JD, Rubin ML, Wolfe SM. Recertification. A continuing debate. Survey of ophthalmology 1980. link90046-6) 20 Lavy U, Bauer CH. Pathophysiology of failure to thrive in gastrointestinal disorders. Pediatric annals 1978. link

    Original source

    1. [1]
      Emergency department management of patients with failure to thrive. — Calleo V, Surujdeo R, Thabet A Pediatric emergency medicine practice (2020)
    2. [2]
      Failure to Thrive: A Prospective Study in a Pediatric Gastroenterology Clinic. — Larson-Nath CM, Goday PS Journal of pediatric gastroenterology and nutrition (2016)
    3. [3]
      RADIATION PROTECTION CABIN FOR CATHETER-DIRECTED LIVER INTERVENTIONS: OPERATOR DOSE ASSESSMENT. — Maleux G, Bergans N, Bosmans H, Bogaerts R Radiation protection dosimetry (2016)
    4. [4]
      "Passing loop" technique: a new modification of the piggyback technique tailored to voluminous liver grafts--case report. — Eldeen FZ, Lee CF, Lee CS, Chan KM, Lee WC Transplantation proceedings (2013)
    5. [5]
      Prognostic assessment in patients with hepatic encephalopathy. — García-Martínez R, Simón-Talero M, Córdoba J Disease markers (2011)
    6. [6]
      Intracranial hemorrhage and liver-associated deaths associated with tipranavir/ritonavir: review of cases from the FDA's Adverse Event Reporting System. — Chan-Tack KM, Struble KA, Birnkrant DB AIDS patient care and STDs (2008)
    7. [7]
      Fulminant hepatic failure: etiology and indications for liver transplantation. — Gotthardt D, Riediger C, Weiss KH, Encke J, Schemmer P, Schmidt J et al. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (2007)
    8. [8]
      The redefinition of failure to thrive from a case study perspective. — Locklin M Pediatric nursing (2005)
    9. [9]
      On bioartificial liver assist system: theoretical exploration and strategies for further development. — Shi Q Artificial cells, blood substitutes, and immobilization biotechnology (2000)
    10. [10]
      Bromfenac (Duract)-associated hepatic failure requiring liver transplantation. — Hunter EB, Johnston PE, Tanner G, Pinson CW, Awad JA The American journal of gastroenterology (1999)
    11. [11]
      Fulminant hepatic failure. — Bernstein D, Tripodi J Critical care clinics (1998)
    12. [12]
      Fulminant hepatic failure associated with bicalutamide. — Dawson LA, Chow E, Morton G Urology (1997)
    13. [13]
      Reduced serum Gc-globulin concentrations in patients with fulminant hepatic failure: association with multiple organ failure. — Schiødt FV, Ott P, Bondesen S, Tygstrup N Critical care medicine (1997)
    14. [14]
      Fulminant hepatic failure: pathophysiology, treatment, and survival. — Atillasoy E, Berk PD Annual review of medicine (1995)
    15. [15]
      Serum tumor necrosis factor (TNF) in the pathogenesis of clinical hepatic failure of HCV and/or HBV infection. — Zhang DF, Ren H, Jia XP, Zhou YS Chinese medical journal (1993)
    16. [16]
      Fluid and electrolyte disturbances in hepatic failure. — Kelso LA AACN clinical issues in critical care nursing (1992)
    17. [17]
      Acute hepatic failure associated with oral minocycline: a case report. — Min DI, Burke PA, Lewis WD, Jenkins RL Pharmacotherapy (1992)
    18. [18]
      Terminal hepatic failure following a small dose of sulfamethoxazole-trimethoprim. — Ransohoff DF, Jacobs G Gastroenterology (1981)
    19. [19]
      Recertification. A continuing debate. — Trobe JD, Rubin ML, Wolfe SM Survey of ophthalmology (1980)
    20. [20]
      Pathophysiology of failure to thrive in gastrointestinal disorders. — Lavy U, Bauer CH Pediatric annals (1978)
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