You are the critical care nurse practitioner covering the ICU at a busy teaching hospital. You are called to accept a transfer from an outside hospital. The patient is a 35-year-old native American female who lives on the Navaho Reservation. Prior medical history includes obesity, T2DM, and ETOH use/abuse. Patient presented to outside hospital complaining of RUQ abdominal pain, nausea/vomiting, jaundice, and confusion.

Per the patient’s husband, she developed nausea/vomiting with body aches 3-4 days ago. She “felt like she had the flu” and was taking Tylenol for the body aches.

Labs from the outside hospital are significant for:

• WBC 12.8 Gl 86 Tbili 20.4
• HGB 9.5 BUN 14 AST 946
• HCT 28.3 Cr 0.83 ALT 1110
• PLT 73 Na 149 ALP 142
• K 4.7
• PT 34.6 Cl 112 Lactic acid 12.4
• INR 3.6 CO2 13 Ammonia 281

Patient’s mental status quickly deteriorated, and she was intubated for airway protection and is being transferred to your facility for higher level care.

Respond to each of the questions below and support your answer with two or three peer-reviewed resources.

1. What are the differentials for acute liver failure?
2. What potential risk factors does this patient have for liver failure?
3. What are the diagnostic criteria for acute liver failure?
4. What are your priorities in the medical management of acute liver failure?
5. What is involved in the pretransplant work-up for liver transplant?
6. Why do you want to avoid transfusions in a potential transplant candidate?

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