Sunday, May 8, 2016

CME Live: Hyperammonaemia and CRRT in acute liver failure

CME Live: Hyperammonaemia and CRRT in acute liver failure

Dr. Timothy Buchman

Curofy- India's largest community of verified doctors covered the CME-International Neonatal and Pediatric Nephrology Training Workshop live. This post was first published on the Curofy app. 

Indication of RRT in ALF
Hepatic encephalopathy grade 3-4
Renal dysfunction
Metabolic abnormalities
No one indication is an absolute one in for initiation of RRT

Supportive therapy for kids who deteriorate
Volume overload, intractable metabolic acidosis, and hyperkalemia
Delay in RRT decreases mortality by 90% 
Serves as a bridge to transplant


CRRT-CVVH, CVVHD CVVHDF- no evidence which was bettter 
TPE- therapeutic plasma exchange 
SPAD: single pass albumin dialysis

No evidence for RRT in liver patients

Should we undertake CRRT in ALF?

Yes and review 
For neuroprotection, metabolic disarray, bridge for recovery or transplant
CRRT- unstable
TPE- the way to go

Dose: No evidence in pediatrics, High is gaining popularity

Anticoagulation: PGI2 and low dose heparin

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