Ep 148 Liver Emergencies: Acute Liver Failure, Hepatic Encephalopathy, Hepatorenal Syndrome, Liver Test Interpretation & Drugs to Avoid

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 10 November 2020

⏱️ 72 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this 1st part of our 2 part series on Liver Emergencies Walter Himmel, Brian Steinhart and Anton discuss: What are the most important causes of acute liver failure that we need to identify in the ED so we can initiate timely treatment? What are some of the common medications we use in the ED that we should avoid in the liver patient? How should we approach the interpretation of liver enzymes and liver function tests? What are the key management steps in treating acute liver and hepatorenal syndrome? Why do liver failure patients become hypoglycemic and how should hypoglycemia in these patients be treated in the ED? How do we diagnose hepatorenal syndrome in the ED? How can the MELD score help us manage liver patients? What are the indications for IV albumin? What is the role of an ammonia level in the diagnosis of hepatic encephalopathy? Is polyethylene glycol a better alternative to lactulose for treating hepatic encephalopathy? and much more...

Transcript

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0:00.0	Welcome to the Emergency Medicine Cases Podcast.
0:05.0	I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.
0:16.0	For such a large organ, ED docs spend proportionally little time thinking about the liver.
0:27.2	Sure, we're often in the neighborhood, whether it be doing a fast or diagnosing billiary disease,
0:32.7	but the liver really doesn't get the credit it's due.
0:36.7	Nonetheless, from time to time, whether it be the serotic patient gushing from a varic
0:41.6	whose INR is greater than his shoe size, where the confused hepatic encephalopathy patient
0:46.9	levitating off the bed using nothing but asteriskses, there are definitely times where
0:52.7	the middle child of the abdomen steals the show.
0:56.2	Today, we're on a mission to reconnect. Liver, meet EM doc.
1:01.5	EM doc, meet the liver. I think you'll really get along if you get to know one another.
1:07.6	And back on the show, we have my good friends with a collective clinical experience of, I
1:13.5	won't say how long, doctors Walter Himmel and Dr. Brian Steinhart, it's great to have you both
1:19.1	back on the show. Good to be here, Anton. So glad to be here. Thanks for having me again.
1:24.4	All right. Well, let's jump right into our case here. A 55-year-old woman, known to your
1:31.7	ED for alcohol use disorder, presents the ED with a four-day history of progressive,
1:37.1	altered mental status, generalized weakness, fever, and abdominal pain. The patient's husband stated that she was confused, complaining of moderate generalized
1:47.9	abdominal pain, and had fevers as high as 39.2 degrees Celsius.
1:53.3	There was no history of headache or neck pain, no nausea, vomiting, diarrhea, dyspnea, cough,
1:59.3	or dysuria.
2:03.3	Her medical history was notable not only for alcohol use disorder, but also for hepatitis C. She's been compliant, according to her husband,
2:09.9	on spyrnalactone and lactylose, and was started on Perkissette two weeks ago after he broke his ankle.
	...

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