[Intensive care of patients with acute liver failure].
BACKGROUND
Acute liver failure and acute decompensated chronic liver failure are two diseases that demand extensive knowledge of etiology and triggering factors, pathophysiology, diagnosis, prognosis and recommended guidelines for treatment. The article defines the diseases, discusses etiological factors, treatment strategies, indications for referral to the transplantation unit at Rikshospitalet and prognostic factors of importance.


METHODS
The basis for this article is literature identified through a non-systematic search in PubMed and the authors' clinical experience and experimental research within the field.


RESULTS
In the Western world paracetamol poisoning and toxic reactions to other drugs are the most common triggering factors for acute liver poisoning in adults. Patients can quickly develop multi organ failure requiring advanced intensive care. The most common complications are hepatic encephalopathy, acute renal failure and coagulation disturbances. Acute decompensated chronic liver failure strikes patients with known liver disease and is most often triggered by inflammation, infection, gastrointestinal bleeding, drugs, traumas or disturbances in acid/base/electrolyte balance. Early diagnosing of triggering factors and intensive medical supportive treatment is especially important. Acute renal failure indicates a very bad prognosis.


CONCLUSIONS
Patients diagnosed with acute liver failure or acute decompensated chronic liver failure remain a clinical challenge. Optimal treatment requires extensive knowledge of pathophysiological mechanisms and treatment strategies.
Ytrebø
Lars Marius
LM
Critical Care Unit, University College London Hospitals NHS Foundation Trust og Institutt for klinisk medisin, Universitetet i Tromsø, Norway. lars.m.ytrebo@uit.no
Klepstad
Pål
P
D000082:Acetaminophen / Q000506:poisoning; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning; D003422:Critical Care / Q000379:methods*; D006530:Hepatorenal Syndrome / Q000175:diagnosis; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D016031:Liver Transplantation; D011379:Prognosis
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen