ICU Vivas · GI & nutrition
Data viva — the liver function tests in the ICU
A data viva on interpreting liver function tests, coagulation and acid-base results after a paracetamol overdose, and applying the transplant selection criteria.
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CICMFFICMEDIC
Prompt
A set of liver function tests and the coagulation from an ICU patient, to be interpreted.
Stimulus
You are shown the results of a 30-year-old with grade 3 encephalopathy, after adequate intravenous fluid resuscitation, following a paracetamol overdose:
| Variable | Value |
|---|---|
| ALT | 4500 U/L |
| AST | 3800 U/L |
| Bilirubin | 65 micromol/L |
| INR | 7.2 |
| Arterial lactate | 4.5 mmol/L |
| Creatinine | 210 micromol/L |
| Arterial pH | 7.28 |
Interpret and manage.[1]
References3ShowHide
- [1]Fernández J, Bassegoda O, Toapanta D, et al. Acute liver failure: A practical update. JHEP reports : innovation in hepatology, 2024.PMID 39170946
- [2]Bernal W, Donaldson N, Wyncoll D, et al. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet (London, England), 2002.PMID 11867109
- [3]Roy A, Kumar Y, Verma N Coagulopathy in acute liver failure. Best practice & research. Clinical gastroenterology, 2024.PMID 39709211