Acute Liver Failure

Acetaminophen induced acute liver failure has a generally benign outcome; nearly three-fourths of cases survive without liver transplant.  Cases that have a poor prognosis are defined by the King’s College Criteria. All of the following are components of the criteria for acetaminophen induced acute liver failure except:

A. arterial pH

B. INR

C. hepatic encephalopathy

D. bilirubin

E. creatinine

The King’s College Criteria for acute liver failure is used to identify cases with a poor prognosis.  It is divided into acetaminophen induced and non-acetaminophen induced cases.  The acetaminophen induced criteria includes arterial pH < 7.30 or all of the following: INR > 6.5, serum creatinine > 3.4 mg/dL and grade III/IV hepatic encephalopathy.  Bilirubin is not part of the criteria.

Non-acetaminophen induced acute liver failure criteria includes INR > 6.5 or three of the following five criteria: age < 11 or > 40, creatinine > 3 mg/dL, INR > 3.5, idiosyncratic drug reaction, bilirubin > 17.5 mg/dL.

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