A 44-year-old man with acute liver failure is ventilated on ICU. He develops agitation despite sedation, INR is 5.2, lactate 4.3 mmol/L, ammonia is

Question

A 44-year-old man with acute liver failure is ventilated on ICU. He develops agitation despite sedation, INR is 5.2, lactate 4.3 mmol/L, ammonia is markedly raised, and pupils remain equal. Sodium is 132 mmol/L and blood glucose is 3.1 mmol/L. What is the most important next step?

Accepted Answer

Correct hypoglycaemia and urgently discuss with a liver transplant centre

Answer

Give intramuscular vitamin K and observe overnight

Answer

Restrict glucose to reduce cerebral oedema

Answer

Perform lumbar puncture to exclude meningitis

Answer

Delay referral until encephalopathy progresses to coma

Acute liver failure — FRCA Final MCQ

A 44-year-old man with acute liver failure is ventilated on ICU. He develops agitation despite sedation, INR is 5.2, lactate 4.3 mmol/L, ammonia is markedly raised, and pupils remain equal. Sodium is 132 mmol/L and blood glucose is 3.1 mmol/L. What is the most important next step?