Acute liver failure laboratory findings: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(26 intermediate revisions by the same user not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Acute liver failure}}
{{Acute liver failure}}
{{CMG}} {{AE}}
{{CMG}} {{AE}} {{HS}}
 


==Overview==
==Overview==
All patients with clinical or laboratory evidence of moderate to severe acute hepatitis should have immediate measurement of prothrombin time and careful evaluation of mental status. If the prothrombin time is prolonged by ≈ 4-6 seconds or more (INR ≥1.5)
Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease. All patients with clinical or laboratory evidence of moderate to severe acute [[hepatitis]] should have an immediate measurement of [[prothrombin time]] and careful evaluation of [[mental status]]. If the [[prothrombin time]] is prolonged (INR ≥1.5) and there is any evidence of altered [[sensorium]], the diagnosis of acute liver failure should be strongly suspected and hospital admission is mandatory.
and there is any evidence of altered [[sensorium]], the diagnosis of ALF should be strongly suspected and hospital admission is mandatory<ref name="Polson">{{cite journal |author=Polson J, Lee WM |title=AASLD position paper: the management of acute liver failure |journal=Hepatology |volume=41 |issue=5 |pages=1179-97 |year=2005 |pmid=15841455 |doi=10.1002/hep.20703}}</ref>.
 
==Laboratory Findings==
==Laboratory Findings==
 
* Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease.<ref name="Polson">{{cite journal |author=Polson J, Lee WM |title=AASLD position paper: the management of acute liver failure |journal=Hepatology |volume=41 |issue=5 |pages=1179-97 |year=2005 |pmid=15841455 |doi=10.1002/hep.20703}}</ref><ref name="pmid16775039">{{cite journal| author=Wasley A, Fiore A, Bell BP| title=Hepatitis A in the era of vaccination. | journal=Epidemiol Rev | year= 2006 | volume= 28 | issue=  | pages= 101-11 | pmid=16775039 | doi=10.1093/epirev/mxj012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16775039  }} </ref><ref name="pmid12753342">{{cite journal |vauthors=Khuroo MS, Kamili S |title=Aetiology and prognostic factors in acute liver failure in India |journal=J. Viral Hepat. |volume=10 |issue=3 |pages=224–31 |year=2003 |pmid=12753342 |doi= |url=}}</ref><ref name="pmid22271089">{{cite journal| author=Torres HA, Davila M| title=Reactivation of hepatitis B virus and hepatitis C virus in patients with cancer. | journal=Nat Rev Clin Oncol | year= 2012 | volume= 9 | issue= 3 | pages= 156-66 | pmid=22271089 | doi=10.1038/nrclinonc.2012.1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22271089  }} </ref>
 
{| class="wikitable"
{| class="wikitable"
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |LAB
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |LAB
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |FORMULA/ VARIABLE
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |values in Acute liver failure
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |NORMAL VALUE
!Comments
! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" + |VALUE IN HHS
|-
|-
| align="center" style="background:#DCDCDC;" + |[[Plasma glucose]] (mg/dL)
| align="center" style="background:#DCDCDC;" + |
* [[Prothrombin time]]/[[INR]]
|
|
* Direct measurement
* Increased
|
|
* < 200 mg/dl
* Prolonged [[prothrombin time]], resulting in an INR ≥1.5; it shows [[coagulopathy]] which is a part of acute liver failure criteria.
|-
| align="center" style="background:#DCDCDC;" + |
*[[Hemoglobin]]
|
|
* > 600 mg/dl
* Low
|
* [[Anemia]] may be present
|-
|-
| align="center" style="background:#DCDCDC;" + |Arterial pH
| colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + |
**[[Liver function tests]] ([[Aspartate transaminase|AST]], [[Alanine transaminase|ALT]], [[alkaline phosphatase]], [[Gamma-glutamyl transpeptidase|GGT]])
| colspan="1" rowspan="1" |
* Elevated
|
|
* [[Blood]] [[pH]]
* [[Liver enzymes]] are elevated in acute liver failure. The decrease in liver enzymes may indicate recovery or worsening of liver failure and an indication of hepatic mass loss.
|-
|
* Total [[bilirubin]]  
|
* Elevated
|
* [[Bilirubin]] and [[INR|PT/INR]] will continue to rise in liver failure but if a patient is improving, bilirubin and PT/INT will also improve.
|-
|
|
* 7.35-7.45
* [[Albumin]]
|
|
* > 7.30
* Low
|
* [[Albumin]] indicates the synthetic function of the liver.
|-
|-
| colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + |[[Anion gap]]
| colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + |
**[[Blood sugar|Blood glucose]]
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
* (Na<sup>+</sup>) – (Cl<sup>–</sup> + HCO3<sup>–</sup>)
* Low
| colspan="1" rowspan="1" |
|
* 7 to 13 (mEq/L)  
* Decrease hepatic [[glycogenolysis]] and [[gluconeogenesis]] 
|-
|
* [[Blood urea nitrogen|BUN and CR]]
|
* Elevated
|
* Decrease clearance in [[hepatorenal syndrome]]
|-
| align="center" style="background:#DCDCDC;" + |
*Toxicology screen ([[Acetaminophen|acetaminophen level]]) and blood alcohol level
|
|
|
* Variable
* Detectable in [[acetaminophen]] poisioning
|-
|-
| colspan="1" rowspan="1" align="center" style="background:#DCDCDC;" + |[[Osmolality|Serum osmolality]]
| align="center" style="background:#DCDCDC;" + |
| colspan="1" rowspan="1" |
*[[Viral hepatitis]] markers: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HEV
* 2([[Sodium|Na]] + [[Potassium|K]]) + ([[glucose]]/18) + ([[blood]] [[urea]] [[nitrogen]]/2.8)
|
| colspan="1" rowspan="1" |
* Dectectable in viral hepatitis
* 285 to 295 mOsm/kg (285 to 295 mmol/kg) of water
|
|
* Increased (> 320mOsm/kg)
* Viral serology and [[PCR]] can detect the viral agent
|-
|-
| align="center" style="background:#DCDCDC;" + |Plasma [[ketones]]
|
|
* Direct measurement
*[[Autoimmune]] markers: [[Anti-nuclear antibody|ANA]], [[Anti-actin antibodies|ASMA]], LKMA, [[Antibody|Immunoglobulin]] levels
|
|
* Negative
* Detectable in auto immune hepatitis.
|
|
* Trace or negative
* Antibody screen can detect antibodies associated with [[autoimmune hepatitis]] such as [[anti-smooth muscle antibody]] or [[ANA]].
|-
|-
| align="center" style="background:#DCDCDC;" + |Urine [[ketones]]
|
|
* Direct measurement
*[[Ceruloplasmin]] Level
|
|
* Negative
|
|
* Trace or negative
* Elevated in [[Wilson's disease|wilson's]] disease
|-
|-
| align="center" style="background:#DCDCDC;" + |[[Serum bicarbonate]]
|
|
* Direct measurement
*[[Lactate|Blood lactate]]
|
|
* 23 - 29 mEq/L
* Elevated
|
|
* > 18 mEq/L
* Blood [[lactate]] is elevated due to decrease [[hepatic]] clearance and [[ischemia]] to hepatic tissue
|-
|-
| align="center" style="background:#DCDCDC;" + |[[Blood urea nitrogen]] ([[BUN]]), [[creatinine]] levels
|
|
* N/A
*[[Ammonia|Ammonia levels]]
|
|
* [[BUN]]: 7-20 mg/dl
* Elevated
* [[Creatinine]] levels: 0.8-1.2mg/dl
|
|
* Increased ([[Dehydration]] and decreased [[renal]] [[perfusion]])
* Decrease [[ammonia]] clearance
|}
|}
Initial laboratory examination must be extensive in order to evaluate both the etiology and severity.
;Initial laboratory analysis<ref name="Polson"/>
*[[Prothrombin time]]/INR
*[[Complete blood count]]
*Chemistries
**Liver function test: [[Aspartate transaminase|AST]], [[Alanine transaminase|ALT]], [[alkaline phosphatase]], [[Gamma-glutamyl transpeptidase|GGT]], total [[bilirubin]], [[albumin]]
**[[Creatinine]], urea/[[blood urea nitrogen]], sodium, potassium, chloride, bicarbonate, calcium, magnesium, phosphate
**[[Blood sugar|glucose]]
**[[Amylase]] and [[lipase]]
*[[Arterial blood gas]], [[lactate]]
*Blood type and screen
*[[Paracetamol]] (Acetaminophen) level, Toxicology screen
*[[Viral hepatitis]] serologies: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HEV
*[[Autoimmune]] markers: [[Anti-nuclear antibody|ANA]], [[Anti-actin antibodies|ASMA]], LKMA, [[Antibody|Immunoglobulin]] levels
*[[Ceruloplasmin]] Level ( when Wilson's disease suspected)
*[[Pregnancy test]] (females)
*[[Ammonia]] (arterial if possible)
*[[HIV]] status (has implication for [[transplantation]])


==References==
==References==

Latest revision as of 22:20, 1 December 2017

Acute liver failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute Liver Failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Acute liver failure laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute liver failure laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acute liver failure laboratory findings

CDC on Acute liver failure laboratory findings

Acute liver failure laboratory findings in the news

Blogs on Acute liver failure laboratory findings

Directions to Hospitals Treating Acute liver failure

Risk calculators and risk factors for Acute liver failure laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease. All patients with clinical or laboratory evidence of moderate to severe acute hepatitis should have an immediate measurement of prothrombin time and careful evaluation of mental status. If the prothrombin time is prolonged (INR ≥1.5) and there is any evidence of altered sensorium, the diagnosis of acute liver failure should be strongly suspected and hospital admission is mandatory.

Laboratory Findings

  • Acute liver failure can present with nonspecific symptoms and it occurs in healthy individuals without a previous history of liver disease. So, the initial labs in the acute liver failure are planned to evaluate both the etiology and the severity of the disease.[1][2][3][4]
LAB values in Acute liver failure Comments
  • Increased
  • Low
  • Elevated
  • Liver enzymes are elevated in acute liver failure. The decrease in liver enzymes may indicate recovery or worsening of liver failure and an indication of hepatic mass loss.
  • Elevated
  • Bilirubin and PT/INR will continue to rise in liver failure but if a patient is improving, bilirubin and PT/INT will also improve.
  • Low
  • Albumin indicates the synthetic function of the liver.
  • Low
  • Elevated
  • Dectectable in viral hepatitis
  • Viral serology and PCR can detect the viral agent
  • Detectable in auto immune hepatitis.
  • Elevated
  • Elevated

References

  1. ↑ Polson J, Lee WM (2005). "AASLD position paper: the management of acute liver failure". Hepatology. 41 (5): 1179–97. doi:10.1002/hep.20703. PMID 15841455.
  2. ↑ Wasley A, Fiore A, Bell BP (2006). "Hepatitis A in the era of vaccination". Epidemiol Rev. 28: 101–11. doi:10.1093/epirev/mxj012. PMID 16775039.
  3. ↑ Khuroo MS, Kamili S (2003). "Aetiology and prognostic factors in acute liver failure in India". J. Viral Hepat. 10 (3): 224–31. PMID 12753342.
  4. ↑ Torres HA, Davila M (2012). "Reactivation of hepatitis B virus and hepatitis C virus in patients with cancer". Nat Rev Clin Oncol. 9 (3): 156–66. doi:10.1038/nrclinonc.2012.1. PMID 22271089.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Acute_liver_failure_laboratory_findings&oldid=1400308"