How are hemodynamic derangements treated 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

Hemodynamic derangements consistent with multiple organ failure occur in acute liver failure. Hypotension (ie, systolic blood pressure < 80 mm Hg) may be present in 15% of patients. Most patients will require fluid resuscitation on admission. Intravascular volume deficits may be present on admission due to decreased oral intake or gastrointestinal blood loss.

Hemodynamic derangement resembles that of sepsis or cirrhosis with hepatorenal syndrome (low systemic vascular resistance [SVR] with normal or increased cardiac output). An arterial line should be placed for continuous blood pressure monitoring.

A Swan-Ganz catheter should be placed, and fluid replacement with colloid albumin should be guided by the filling pressure. If needed, dopamine or norepinephrine can be used to correct hypotension.


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