Critical Care Scenarios Episode 15: Liver failure with Elliott Tapper
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Sep 6, 2020 Join Dr. Elliott Tapper, a leading gastroenterologist and transplant hepatologist from the University of Michigan, as he dives into the complexities of liver failure. He emphasizes the importance of infection management in cirrhotic patients and unpacks the intricacies of lab result interpretation. The discussion navigates the delicate balance in treating hepatic encephalopathy and the critical role of multidisciplinary collaboration. Tune in for insights on managing spontaneous bacterial peritonitis and prognosis discussions with families in critical situations.
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Treat Encephalopathy Clinically, Not By Ammonia
- Start lactulose immediately for suspected hepatic encephalopathy and titrate to clinical response rather than waiting for ammonia results.
- Add rifaximin for secondary prevention or if encephalopathy was severe enough to hospitalize the patient.
Stop Chasing Ammonia Levels
- Do not routinely chase ammonia measurements; treat suspected encephalopathy clinically and address triggers like infection.
- Recognize ammonia assays are technically sensitive and can be misleading if mishandled.
Ammonia Levels Are Unreliable
- Ammonia levels poorly correlate with clinical encephalopathy because of measurement issues and other contributing factors like inflammation.
- Rely on the clinical picture and treat triggers rather than chasing ammonia lab values.