{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 19, Ep 2 of 2: Acute Liver Failure and the King's College Criteria","html":"","width":"100%","height":180,"duration":974,"description":"Episode two shifts from the drug to the failing organ, asking whether the liver can still recover on its own, how much time you have to decide, and when a different liver is the only answer. It anchors on the four-criterion definition of acute liver failure, then shows how etiology maps directly to the probability of spontaneous recovery. Two special causes, Wilsonian and herpes acute liver failure, each carry a distinctive fingerprint that demands empiric therapy before the workup completes. The King's College Criteria then triage who gets listed, with separate acetaminophen and non-acetaminophen paths calibrated to that recovery probability.\n \nTopics covered\n\nThe four-criterion definition of acute liver failure\nDistinction from acute-on-chronic failure and cerebral edema\nEncephalopathy grading one through four\nEtiology distribution and its link to prognosis\nNon-cerebral and cerebral edema management\nWilsonian acute liver failure and its fingerprint\nHerpes acute liver failure and empiric acyclovir\nN-acetylcysteine in non-acetaminophen failure\nKing's College Criteria and transplant listing\n \n \nKey decisions\n\nAcute liver failure requires all four criteria: an INR of at least one and a half, hepatic encephalopathy of any grade, total illness duration under twenty-six weeks, and no pre-existing cirrhosis.\nCerebral edema risk rises sharply at grade three or four encephalopathy, and arterial ammonia above roughly a hundred fifty to two hundred marks the threshold where herniation risk climbs, managed with head-of-bed elevation, hypertonic saline, mannitol, and continuous renal replacement.\nThe Wilsonian fingerprint is Coombs-negative hemolysis with high indirect bilirubin, an alkaline-phosphatase-to-bilirubin ratio under four, an AST-to-ALT ratio over two, low uric acid, and Kayser-Fleischer rings, treated with urgent transplant and bridged by plasmapheresis while avoiding penicillamine.\nHerpes acute liver failure shows very high transaminases with a normal or low...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}