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How to Treat Liver Failure?
Things to note:
- Patient education.
- Avoid hepatotoxic drugs and alcohol.
- Rest and reduced physical activity are recommended.
- Normal diet. Protein restriction indicated only when encephalopathy is evident. Severe protein restriction may accentuate catabolism. Use increments
- of 20 g protein per day as tolerated.
- Monitor blood glucose regularly because hypoglycaemia is common. Correct electrolyte disturbances.
- Exclude GI bleed as precipitant.
- Avoid any measure, e.g. drugs, that may worsen or precipitate functional deterioration.
- Avoid vigorous paracentesis.
- Exclude infection as precipitant, especially spontaneous bacterial peritonitis.
On admission to change pH of large bowel:
- Lactulose, oral, 10-30 mL immediately.
Thereafter, to attain 2-3 soft stools a day:
- Lactulose, oral, 10-30 mL 8 hourly.
- Titrate dose to 2-3 soft stools a day.
- Vitamin K1, IM/IV, 5-10 mg daily.
Other vitamins if indicated. Multivitamin supplements should be considered and may be indicated. When to refer:
- All cases with severe acute or advanced chronic liver failure.
- Where a liver transplant is to be considered.