Drug-Induced Adverse Hepatic Interactions/Reactions

First Things First (assess & treat for the following)

• Does pt have evidence of fulminant hepatic failure or liver dysfunction that requires immediate attention?
  • Cerebral edema
    • Increased muscle tone
    • Abnormal pupillary reflexes
    • Decorticate/decerebrate posturing
    • Hypertension/bradycardia (Cushing’s reflex)
  • Hepatic encephalopathy
    • Stage III: stupor
    • Stage IV: coma
  • Coagulopathy w/ bleeding
    • PT >15 sec, PTT >50 sec
  • Thrombocytopenia w/ bleeding: platelets < 50,000
  • Circulatory collapse: mean arterial BP < 55 mmHg
    • Hemorrhage
    • Sepsis
  • Significant hypoglycemia < 80 mg/dL
  • Acute renal failure
  • Lactic acidosis pH < 7.25, lactate >2.5
  • Hepatopulmonary syndrome w/ hypoxemia PaO2< 55 mmHg
  • Pulmonary edema