Fulminant Hepatitis

Fulminant hepatitis is an older clinical label for acute liver failure. Acute liver failure is a life-threatening, potentially reversible syndrome in a person without known pre-existing liver disease: an acute hepatic injury causes coagulopathy with an INR >1.5 and hepatic encephalopathy. Encephalopathy may begin with subtle inattention, altered sleep, irritability, or confusion and can progress to somnolence, loss of airway protection, and coma. The defining problem is loss of liver function, not simply a high aminotransferase result. Extensive hepatocyte injury reduces detoxification and synthesis. Accumulating neurotoxins, including ammonia, contribute to astrocyte swelling and cerebral edema. Reduced synthesis of clotting proteins raises the INR, but the INR is a marker of impaired synthesis and prognosis rather than a dependable measure of bleeding risk. Impaired glucose regulation can produce hypoglycemia. Kidney injury, circulatory failure, infection, metabolic disturbance, and respiratory failure may accompany progression. Cerebral edema and progressive multiorgan dysfunction are major threats. Acetaminophen toxicity, other drug-induced liver injury, viral hepatitis, ischemic injury, autoimmune hepatitis, Wilson disease, vascular obstruction, and pregnancy-related liver disease are important causes. A medication, non-prescription product, natural health product,...