Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Management of Hepatic Failure by zjm11893

VIEWS: 4 PAGES: 1

Management of Hepatic Failure document sample

More Info
									MANAGEMENT OF FULMINANT HEPATIC FAILURE

Definition - encephalopathy developing within 8 weeks of the onset of hepatic
symptoms.

Encephalopathy: Grades

I      Mild confusion; euphoria or depression with disturbed sleep.
II     Moderate confusion; lethargy.
III    Marked confusion; sleeping but rousable.
IV     Coma.

Early Management

Patients with moderate jaundice, grade I - II encephalopathy.

       - exclude protein
       - lactulose (osmotic laxative) 30-50 mls hourly until diarrhoea, then 30 mls tds.
       - dextrose to avoid hypoglycaemia.
       - hydration.
       - ranitidine as H2 antagonist.
       - neomycin 0.5 - 1 g 6 hourly.
       - measure lactate.
       - consider early dialysis.

Middle Period

Grade II - III encephalopathy.

       - PA catheter: Colloid to maintain filling.
       - low dose dopamine.
       - HD for creatinine > 400 mmol/l

Late Phase

Grade IV encephalopathy with renal failure.

       - treat cerebral edema: mannitol 0.5 g/kg q6h until serum osmolarity exceeds
        320 mosm/l, ventilation with relaxant.
       - coagulation factors as required.
       - look for infection.




SJH et al.Jan 93

								
To top