What are the treatment options for cerebral edema in patients with acute liver failure (ALF)?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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Answer

There is increasing evidence that ammonia may play a pathogenic role in the development of cerebral edema. Reducing elevated ammonia levels with enteral administration of lactulose might help prevent or treat cerebral edema. In the late stages of encephalopathy, to reduce the risk of aspiration, avoid providing lactulose by mouth or nasogastric tube in the absence of endotracheal intubation.

The occurrence of cerebral edema and intracranial hypertension (ICH) in patients with acute liver failure is related to the severity of encephalopathy. Cerebral edema is seldom observed in patients with grades I-II encephalopathy. The risk of edema increases to 25-35% with progression to grade III and increases to 65-75% (or more) in patients reaching grade IV coma.


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