Episode 84: Acute liver failure with Sergio Navarrete

In this episode of Critical Care Scenarios, Brandon Odo and Brian Bolling host Dr. Sergio Navarrete to discuss acute liver failure in the ICU. The discussion begins with a clinical case of a 41-year-old male with a history of hepatitis B and mild cirrhosis who develops acute liver failure secondary to septic shock. The speakers delve into recognizing and managing liver involvement in critically ill patients, differentiating between "shock liver" and more specific liver problems. They explore diagnostic approaches, including lab monitoring (LFTs, INR, fibrinogen, blood sugars) and vascular imaging, and discuss the importance of optimizing hemodynamics, considering both left and right heart function to avoid congestive hepatopathy. The panel also discusses complications like hypoglycemia and cerebral edema, and rescue therapies such as CRRT and liver-targeted modalities. Finally, they address the critical decision-making around liver transplantation, including patient selection, timing of referral, and factors influencing transplant candidacy.