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

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Last updated: May 20, 2010