TY - CHAP M1 - Book, Section TI - Liver Failure: Acute and Chronic A1 - Kim, Brian A1 - Kim-Schluger, Leona A2 - Oropello, John M. A2 - Pastores, Stephen M. A2 - Kvetan, Vladimir PY - 1 T2 - Critical Care AB - KEY POINTSAcute liver failure (ALF) is defined as the rapid and severe development of liver dysfunction, marked by encephalopathy and coagulopathy in an individual without a prior history of cirrhosis or liver disease.Acetaminophen is the most common cause of ALF in the United States, and prompt administration of N-acetylcysteine helps to decrease mortality in acetaminophen hepatotoxicity. N-acetylcysteine may also have some benefit in nonacetaminophen hepatotoxicity.Supportive care remains the mainstay of ALF management. Spontaneous survival rate from ALF is 40% and liver transplantation (LT) remains the only definitive therapy for patients who are unable to achieve timely regeneration of liver mass to maintain life despite adequate supportive care.Cirrhosis is characterized by progressive hepatic fibrosis that can lead to consequences of portal hypertension including variceal hemorrhage, ascites, renal failure, and encephalopathy.The combination of pharmacologic therapy and endoscopic variceal ligation is effective in controlling bleeding in up to 90% of patients presenting with acute variceal hemorrhage.Hepatic encephalopathy is a frequent reason for hospital admissions. Common precipitants, such as infection, dehydration, and bleeding, should be ruled out in any patient presenting with hepatic encephalopathy. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1136415251 ER -