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King's College Criteria ALF — FRCA Final MCQ

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HardIntensive Care MedicineKing's College Criteria ALFFRCA Final

A 70-year-old man (ASA III) is in the ICU with acute liver failure from paracetamol overdose. His INR is 6.5, pH 7.18, creatinine 350 μmol/L, and he is developing grade III hepatic encephalopathy. According to the King's College Hospital criteria for paracetamol-induced ALF, which single criterion indicates the need for liver transplant listing?

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Correct answer: C — Bilirubin >300 μmol/L

The King's College Hospital criteria for liver transplantation in paracetamol-induced acute liver failure: pH <7.30 (after fluid resuscitation) is a SINGLE indicator. OR all three of: INR >6.5 (PT >100 seconds), creatinine >300 μmol/L, AND grade III-IV encephalopathy. This patient meets the composite criteria (INR 6.5, creatinine 350, grade III encephalopathy) and the pH criterion (7.18 <7.30). He should be discussed urgently with a liver transplant centre. NAC should be continued. Artificial liver support and ICU management are bridge-to-transplant therapies.

Reference: O'Grady JG et al – 1989 – KCH criteria; NICE – 2019 – CKS Paracetamol overdose