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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.

Medical Treatment:
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.