Hepatic Failure/GI/Endocrine Emergencies

Learning Objectives

Develop a treatment strategy to help manage and

reduce the complications associated with acute liver

failure (ALF).

surgical management of acute pancreatitis based on

the severity of an episode.

Identify risk factors and treatment options for

gastrointestinal fistulas, postoperative ileus, and

postoperative nausea and vomiting.

Design a treatment plan for patients who present

with an acute upper gastrointestinal bleed.

Differentiate between the main endocrine emer-

gencies in the intensive care and their appropriate

treatment regimens.

Acute liver failure

AP

Acute pancreatitis

BG

Blood glucose

CIRCI

Critical illness–related corticosteroid

insufficiency

CPP

Cerebral perfusion pressure

CT

Computed tomography

DILI

Drug-induced liver injury

DKA

Diabetic ketoacidosis

ED

Emergency department

ERCP

Endoscopic retrograde

cholangiopancreatography

GI

Gastrointestinal

HHS

Hyperosmolar hyperglycemic state

ICP

Intracranial pressure

ICU

Intensive care unit

INR

International normalized ratio

MRI

Magnetic resonance imaging

failure

NG

Nasogastric

NJ

Nasojejunal

NSAID

Nonsteroidal anti-inflammatory drug

POI

Postoperative ileus

PONV

Postoperative nausea and vomiting

PPI

Proton pump inhibitor

SIRS

Systemic inflammatory response syndrome

T3

Triiodothyronine

T4

Thyroxine

TIPS

Transjugular intrahepatic portosystemic

shunt

TPN

Total parenteral nutrition

TSH

Thyroid-stimulating hormone

UGIB

Upper gastrointestinal bleeding

Self-Assessment Questions

Answers and explanations to these questions can be

found at the end of this chapter.

Questions 1 and 2 pertain to the following case.

A 25-year-old woman is brought to the emergency

department (ED) after a suspected overdose of acet-

aminophen. The time of ingestion is unknown. On

presentation, her acetaminophen concentration is unde-

tectable, but her alanine aminotransferase (ALT) and

aspartate aminotransferase (AST) concentrations are

3500 IU/L and 2500 IU/L, respectively. The patient is

markedly confused with incoherent speech, but arous-

able. Other pertinent laboratory values include bilirubin

3.0 mg/dL and alkaline phosphatase 500 IU/L. White

blood cell count is 12 × 103 cells/mm3, platelet count is

90,000/mm3, and international normalized ratio (INR) is

2.6.

Which option best represents the two signs or

symptoms that would qualify this patient for a diag-

nosis of acetaminophen-induced acute liver failure

(ALF)?

pected acetaminophen-induced ALF?

men, continuing if necessary until signs and

symptoms of ALF have resolved.

time because her acetaminophen concentration

is undetectable.

teine may be used because the two routes are

similarly efficacious.