Prognosis in a patient with acetaminophen-induced liver injury^*

The algorithm represents the Modified King's College Criteria with sensitivity 0.95 and specificity 0.91 for mortality without liver transplantation. Height of AST/ALT elevation is not used in the algorithm and is not prognostic. Refer to UpToDate content for further discussion on management of acetaminophen toxicity and acute liver failure.

ABG: arterial blood gas; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; INR: international normalized ratio; IV: intravenous; PT: prothrombin time.

* Patients with AST or ALT >1,000 U/L and acetaminophen exposure (eg, history of acute ingestion or repeat supratherapeutic dosing).

¶ Type and amount of crystalloid solution for fluid resuscitation depends on clinician preference and patient characteristic such as vital signs, evidence of hypoperfusion, ejection fraction, presence of pulmonary edema, and kidney impairment.

References:

O'Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97:439.
Bernal W, Donaldson N, Wyncoll D, Wendon J. Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet 2002; 359:558.

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Prognosis in a patient with acetaminophen-induced liver injury*

Prognosis in a patient with acetaminophen-induced liver injury^*