Therapeutic Handbook - GGC Prescribing

Consider:• Serum caeruloplasmin, 24 hour urinary copper, Kayser Fleischer rings to be assessed byOphthalmologist for Wilson’s disease.• Doppler US of hepatic vein if Budd-Chiari suspected.• EEG if doubt about the aetiology of cerebral dysfunction.General management and treatment optionsSeek senior help early. ITU admission will be required for all grades of encephalopathy in theacute patient. Your consultant should be aware of the patient on the day of admission so thatearly discussions can take place with relatives and the Liver Transplant Unit if needed.General• Monitor urine output hourly, blood glucose every 2 hours.• Do not sedate.• Avoid arterial puncture (except in paracetamol overdose where a lactate level providesimportant prognostic information).Encephalopathy• If Grade II or worse on presentation, and cerebral oedema is suspected, nurse 20 - 30 O headelevated and give:Mannitol IV 20% , 0.5 g/kg over 30 - 60 minutes and repeat 4 hourly if necessary.Hypoglycaemia• Glucose IV 10% at a rate of 100 ml/hour. For profound hypoglycaemia see guideline onManagement of Hypoglycaemia on page 288.• Continuous infusion of glucose may cause hyponatraemia which may itself be acontraindication to liver transplantation. Therefore the recommendation is to giveconcurrent:Sodium chloride IV 0.9% plusPotassium chloride IV 40 mmol/L if hypokalaemic.Coagulopathy• Do not give blood products (i.e. fresh frozen plasma, factor concentrates) unless bleeding isa problem.• Vitamin K (phytomenadione) does not correct clotting defect but give:Phytomenadione 10 mg slow IV bolus over 3 - 5 minutes to ensure patient is replete.Gastrointestinal SystemContinues on next pagePage 63