What is the management of a patient with acute liver failure due to paracetamol overdose?
ABCDE approach
Prompt intubation and ventilation for low GCS to prevent aspiration and facilitate management of brain oedema
CT head should be considered to rule out any other potential causes of GCS deterioration
Measures to prevent and decrease cerebral edema:
PaO2 >10 kPa; PaCO2 between 4.5 to 5.5 kPa
Avoid measures that could increase intracranial pressure such as ET tube ties (instead use tapes to secure the ET tube)
Deep sedation to avoid cough and strain, and decrease the metabolic demands of the brain
Aiming for serum Na>145 mmol/L
Avoid hyperthermia
Hypertonic solutions such as mannitol if there are signs of brain herniation or dilated unreactive pupils
Cardiovascular support: fluid resuscitation with albumin and crystalloids; vasopressors may be required
Supportive care for metabolic acidosis: haemofiltration
Do not to correct coagulopathy unless actively bleeding (because the coagulation profile is used when in the assessment of potential for liver transplantation)
