"improving intensive care in Scotland"

Liver failure

Transfer to a specialist liver unit

Liver units will discuss with you ANY patient with AHF about whom you are concerned. They welcome early (and ongoing) discussion of patients. The decision to transfer the patient to a liver unit will be influenced by a number of factors besides the patient’s clinical condition – the distance involved, the need for transplantation, and the necessity (or not) of super-urgent listing for transplant.


Criteria for transfer to a specialist liver unit

Paracetamol induced AHF

These patients should be transferred if:

Any PT is greater than the number of hours since overdose, or > 50 seconds.
Or there is persistent metabolic acidosis pH <7.35 h=""> 45) after fluid resuscitation
Or hypoglycaemia
Or encephalopathy

Non-paracetamol induced AHF

Transfer criteria include:

pH <7.3 h=""> 50)
PT > 20 seconds
Oliguria or renal failure
[Na+] < 130 mmol l-1
[bilirubin] > 300 umol l-1
Shrinking liver size


Apart from the patient’s demographic data, GP and contact details at the hospital, they will want to know:

  • The date, time and treatment of paracetamol overdose
  • The patient’s psychiatric history
  • ABG, bilirubin, serial prothrombin time measurements, U&E, glucose
  • Hepatitis A and B status
  • Cardiovascular, respiratory and renal status
  • GCS
  • Next of kin

Patients can deteriorate significantly in transit. Have a low threshold for placing invasive monitors and tracheal intubation before leaving the primary hospital.

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