Liver failure Complication Treatment

Treatment for Acute Liver failure Complication: hepatic encephalopathy

1. 14-amino acid 800 and 6-amino acids 520, the former is used for cirrhotic hepatic encephalopathy. Both of which contain branched-chain amino acids, non-aromatic amino acid. Usage: for the 6 - amino acid 520, per 250ml, daily 2 times, and equivalent of 10% glucose plus L-acetyl amino acid 500mg, slow intravenous drip, to halve the amount after patient clear up, treatment 5 to 7 days. Use 14-amino acid 800 to consolidation effect. Attention to Sohamine or higher Freamine contain tyrosine, phenylalanine, methionine, it can trigger hepatic encephalopathy.

2. L-dopa and dopa-card: Usage is the L-dopa 100mg, carbidopa 10mg 10% glucose 500ml, slow intravenous infusion, 1 or 2 times a day. And the two drugs can reduce the L dopa's side effects.

3. Control of ammonia generated from the following:

1) clean colon hydrotherapy: 30ml vinegar with 1000ml saline plus colon hydrotherapy, colon hydrotherapy, or normal saline, 2 times a day. 50% of colon hydrotherapy after 30ml of lactulose and neomycin 100mg plus 100ml saline retention enema.

2) oral metronidazole or ampicillin.

3) lactulose therapy: acidification of intestinal environment may reduce the blood ammonia, removal of endotoxemia. Usage of 50% lactulose 30 ~ 50ml, 3 times a day, oral (nasal feeding coma can) to meal service appropriate to paste twice daily schedule will prevail.

Treatment for Acute Liver failure Complication: Cerebral edema

Prevention is more important than treatment. When the knee hyperreflexia, ankle clonus or pyramidal tract showed positive, the effect is better.

1. dehydrating agent: 20% mannitol or 25% of pear alcohol per 250ml, the rapid intravenous infusion of vasopressin in drops within 20 ~ 30min after this point is very important. After every 4 to 6 hours with 1 and, if necessary, between the dehydrating agent in the two plus furosemide. If the mind can be reduced by half the volume of a turn for the better, but does not extend the interval to avoid rebound. sorbitol dehydration less than mannitol, without the side effects caused by hematuria. heavy hepatitis when cerebral edema appear safer choice of sorbitol.

2. Dexamethasone: 10mg use for 10% glucose after intravenous injection amount, every 4 to 6 hours with 5mg combined with the dehydrating agent, once a 2 ~ 3.

Treatment and control for Acute Liver failure Complication: Hemorrhage:

1. added clotting factor: Most of the short half-life of coagulation factors, the selection of fresh frozen plasma as well. The application of prothrombin complex concentrate (PPSB) containing Ⅱ, Ⅴ, Ⅶ, Ⅸ four coagulation factors, the effective daily amount of 10U / kg.

2. H-2 receptor antagonist: the prevention of stomach bleeding. Owners of such drugs in liver and kidney metabolism, there have been reports of piperaquine Fenpropathrin microphone side effects are liver damage, so use of ranitidine (Ranitidine), use for 150mg, per night 1 times fewer side effects, better efficacy.

3. reduce the portal pressure: selection of propranolol, the dose in order to slow down the heart rate of 25% for the degree, with the H-2 receptor blocker combination, can reduce the dose.

4. thrombin: erosion of the gastric mucosal bleeding, oozing bleeding were satisfied with the results, when the bleeding stopped, the medication may reduce or extend the interval. Usage for 2000 ~ 10000U / times, once every 4 ~ 6 hours 1 times.

Treatment and prevention for Acute Liver failure Complication: Infection

1. to strengthen the mouth, skin care, strict disinfection and isolation, sterile operation, so that indoor air purification, prevention of respiratory tract infection.

2. endotoxemia: 0.5g amoxycillin available 1 hour use of intestinal bacteria effectively. Or each Lactobacillus Granules 10g, 2 or 3 times a day using them, can inhibit bacterial.

3. bacterial infection: selection of the liver, kidney non-toxic antibiotics.

1) ampicillin: Daily 6 ~ 8g, fractionated infusion. Applicable to E. coli infection.

2) penicillin amlodipine; Department of ampicillin and cloxacillin in Contour mixed goods, daily 6 ~ 8g, graded intravenous injection of Escherichia coli, Staphylococcus aureus and effective.

3) amikacin: 0.2g every 8 hours 1 times by intramuscular injection, the same dose can be used in emergencies intravenous infusion, daily 2 times lower nephrotoxicity than gentamicin.

4) cephalosporins: apply to serious infection, particularly Gram-negative bacilli infections. There are commonly used cefazolin (Vanguard V), the first Mortierella furostanol new (West edge Yan) or third-generation cephalosporins such as ceftazidime (Fortum), ceftriaxone (Hartridge strains), cefoperazone (Pioneer will).

5) A Sodium triazole (metronidazole): used for anaerobic infections, the use for each 400mg, 3 times a day to take. a serious infection, such as adult exudate per 100ml plus metronidazole 500mg, in the vein 20min ~ 30min infusion, 2 times daily. attention to pregnant women, breastfeeding, central nervous system diseases, heart disease, blood disabled patients.

6) antifungal drugs; have oral fungal infections are available nystatin, amphotericin B Miconazole (Miconazole). deep fungal infection fluconazole can be selected, should be noted that liver and kidney dysfunction used with caution. ketoconazole and should guard against liver damage. can use garlic injection, Adult day 60 ~ 120mg, plus 5 % 500 ~ 1000ml glucose infusion, treatment 2 weeks.

Treatment for Acute Liver failure Complication: Renal failure

Renal failure is the first death reason in Acute Liver failure, prevention is more important than treatment. Such as controlling the volume of liquid to avoid kidney damage drug use. Permeable diuretics used early, improve the microcirculation of drugs, such as the prevention of hyperkalemia. Hemodialysis and peritoneal dialysis rarely effective. In recent years, useful prostaglandin E1, E2 appointment to improve liver and kidney syndrome.

Treatment and prevention for Acute Liver failure Complication: Electrolyte acid-base balance disorders

From the onset, according to blood gas analysis and electrolyte changes, actively adjust treatment. Such as metabolic alkalosis, respiratory alkalosis combined metabolic poisoning, metabolic acidosis, Hyponatremia, low calcium, low magnesium, low blood potassium.