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Board Questions

1. Which of the following is NOT a standard therapy for acute liver failure? 

a) Reduced protein intake
b) Support with dextrose infusion
c) Vitamin K
d) Sedatives to limit agitation

2. What lab test may help differentiate coagulopathy secondary to ALF vs DIC? 

a) PT
b) Factor V
c) D dimer
d) Factor VIII

3. True or False: Patients with ALF should be transfused FFP at an INR >3 ? 

a) True
b) False


ANSWERS & EXPLANATIONS

1. D. Sedatives should be avoided in patients with ALF as their mental status and neurological examination is critical. Furthermore, hepatic elimination of drugs may be impaired and there is some evidence that benzodiazepenes may exacerbate encephalopathy

2. D. Factor VIII is produced by the endothelium, not the liver and hence, is often normal or elevated in ALF whereas it is consumed and thus low in DIC. 

3. B False. The coagulopathy of ALF can lead to a propensity to bleed or potentially to clot. This is due to the impaired synthesis of both clotting factors as well as anticoagulant factors such as protein C and S. Hence, therapy with FFP is generally reserved for patients with clinical evidence of bleeding. 
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