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Acute Liver Failure

  • August 26, 2015 11:30 AM EDT

    Recent publications in the veterinary literature (from the Journal of Veterinary Emergency and Critical Care and JAVMA), on the topic of acute liver failure and hepatic encephalopathy, are the subject of the next two VetVine Evidence Based Updates. The clinical review includes discussion of various etiologies of acute liver failure, an emphasis on prognostic indicators and treatment, as well as findings regarding hepatic encephalopathy and treatment in veterinary patients.

    In acute liver failure, the direct or indirect effects of the inciting cause (toxic, infectious, etc.) leads to impairment of liver function including its synthetic, excretory, and regulatory processes. This is in contrast to liver injury, in which liver function is maintained. The consequences of impaired liver function include altered glucose homeostasis, production of protein and coagulation factors, and metabolism of the by-products from biologic and physiologic processes.

    The clinical presentation of canine and feline patients with acute liver failure is typically non-specific except for the presence of icterus.

    Clinicopathologic abnormalities in patients with acute liver failure often include elevations in transaminases (ALT, AST), and Alkaline Phosphatase (ALP). Additionally, we commonly see affected patients with hyperbilirubinemia, hypoglycemia, and hypoalbuminemia.

    Part I of this series on acute liver failure includes discussion of:

    • Idiopathic hepatic lipidosis in cats
    • The importance of frequent monitoring and the prognostic significance of:
      • Electrolytes (potassium)
      • Lactate
      • Ammonia
      • Hemostatic factors
    • Complications and management of:
      • Coagulopathy
      • Sepsis
      • Hepatic encephalopathy
    • Supportive treatment measures
      • Fluid therapy
      • Other considerations
    • Nutritional management of patients with acute liver failure
      • Dietary recommendations
      • Vitamin supplementation
      • Hepatic support - the role of supplements including silymarin and SAMe
    • Prognosis and prognostic indicators


    View Part I of this Evidence Based Update - it's available for On Demand viewing (running time 45 mins; Approved for CE credit in New York and by the NJVMA, pending approval for CE credit by AAVSB RACE).


  • September 3, 2015 10:05 AM EDT

    Part II on the topic of Acute Liver Failure includes a discussion on the drugs, toxins, and infectious diseases that can cause hepatotoxicity.

    We learn about toxic plants, algae, fungi, mushrooms, Leptospirosis, Canine Adenovirus I, xylitol (a widely available sugar substitute), various drugs, and their treatment.

    View Part II of this Evidence Based Update - it's available for On Demand viewing (running time 26 mins; Approved for CE credit in New York and by the NJVMA, pending approval for CE credit by AAVSB RACE).

    • 148 posts
    September 3, 2015 10:52 AM EDT

    On the topic of supplements and hepatic support (covered in Part I of this series), I had the opportunity to serve as Moderator of Dr. Keith Richter's lecture on canine chronic hepatitis at the 2014 AVMA Convention and jotted down these dosages:

    Vitamin E:  10 - 15 units / kg (water soluble form)

    SAMe: 20 mg/kg/day (round up); give on an empty stomach. Available in 90mg, 225mg, and 450mg tabs)

    Losartin (an anti-fibrotic): 0.5 mg/kg BID

  • October 7, 2015 12:41 PM EDT

    This week's Evidence Based Update Roundtable discussion included more information on Xylitol Ingestion in dogs. Dr. Melissa Holahan discussed findings reported in a recent publication from the Journal of Veterinary Emergency and Critical Care.