Eng / JAUNDICE
.pdf
During ALF with the development of coma, the following stages are distinguished:
precoma I:
deterioration of the general condition;
emotional lability;
violation of attention;
sleep disturbance;
sense of anxiety;
memory lapses;
slowness of thinking;
nausea;
handwriting disorder
Loss of orientation in time and space
Precoma II:
further increase in intoxication;
* repeated vomiting; increase in jaundice;
* reduction in the size of the liver;
* confusion of consciousness;
* disorientation;
* psychomotor agitation;
* its transition into deep depression and drowsiness;
* the appearance of "liver smell" from the mouth;
* oral automatism; disorientation in time, space, personality. short-term loss of consciousness
speech slowdown.
the presence of a reaction to painful stimuli.
clinical signs of cerebral edema: flushing and sweating of the face, hiccups, hallucinations, yawning, increased blood pressure.
coma I (shallow):
sopor;
*maintaining a reaction to strong stimuli; * increased hemorrhagic syndrome;
*the appearance of pathological reflexes;
*possible convulsions;
* involuntary urination and defecation; * the appearance of edematous syndrome.
wide pupils with an almost complete lack of reaction to light, symptom of "floating" eyeballs;
coma II (deep):
lack of consciousness;
* areflexia;
complete loss of reaction to irritants; sphincter paralysis.
the appearance of periodic breathing of the Kussmaul or Cheyne-Stokes type.
treatment of fulminant liver failure
. 2. Diet - protein-free, easily digestible (if necessary - enteral nutrition).
Siphon lavage of the stomach and intestines with 2% sodium bicarbonate solution - 2 times a day.
Plasmaphoresis (in the absence of contraindications).
Glucocorticosteroids (GCS) lasting 5-10 days. Preferably prednisolone at a dose of 3-5 mg / kg / day. (every 3-4 hours) intravenously or in combination with intramuscular injection.
treatment of fulminant liver failure
Обязательные мероприятия:
Detoxification therapy with the formation of diuresis
using 5-10% glucose solutions (daily dose of glucose up to 5 g / kg). Forcing diuresis is carried out with saluretics in the usual therapeutic doses with the obligatory prescription of aldosterone antagonists - spironolactone (verospiroc, aldactone) at a dose of 150200 mg / day. And saluretics (under the control of the level of Na and K in the blood plasma).
l-ornithine-l-aspartate at a dose of 20 g/day in 500 ml of infusion solution
treatment of fulminant liver failure
To eliminate all types of hypoxia, hyperbaric oxygen therapy (HBO) is indicated, especially in the precoma stage. GCS in this case is better to prescribe in the form of 2 drugs - dexamethasone (better penetrates through the BBB) at a dose of 0.3-0.4 mg / kg and the rest of the dose - prednisolone.
In the treatment of ALF, cerebral edema, coagulopathy, the most promising and effective is the use of an artificial liver followed by liver transplantation, which, for a number of reasons, makes this method inaccessible.
Emergency care for acute liver failure
The patient must be immediately admitted to a medical facility. Treatment consists of the
following activities:
Infusion therapy (administration of solutions intravenously to maintain blood pressure and detoxification).
Includes glucocorticosteroids (hormones of the adrenal cortex), glucose (for adequate energy support of the body), isotonic sodium chloride solution.
Forcing (stimulating) diuresis (furosemide).
Reducing the formation of ammonia (lactulose is used).
Antibacterial therapy (metronidazole, cephalosporins).
Tranquilizers for mental and motor agitation (diazepam, sodium hydroxybutyrate).
Oxygen therapy (oxygen inhalation).
As additional methods, they use hemosorption, hyperbaric oxygenation, exchange blood
transfusion, etc.
Thank you for attention!