Acute liver failure: how to act?

Acute liver failure (ALF) is a life-threatening condition that occurs as a result of hepatocytes’ severe damage and is accompanied by a high mortality rate due to the rapid development of progressive multiorgan failure, coagulopathy, concomitant infection or the development of cerebral edema. In the context of pathogenesis of ALF, a separate role belongs to the development of hepatic encephalopathy, which occurs as a result of an amino acid imbalance and the release of endogenous neurotoxins, the main of which is ammonium. Accumulation of ammonium in neuroglia cells leads to swelling of astrocytes, activation of inflammatory mediators, increased cerebral blood flow and brain edema. In the context of the close relationship between endogenous neurotoxins (ammonium) and the development of cerebral complications in ALF, it will be appropriate to prescribe treatment to reduce its concentration in the blood, which will prevent the hepatic encephalopathy progression and the development of intracranial hypertension. Consequently, lowering the ammonium blood level should be considered as a therapeutic goal in the management of patients with ALF.

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