Patiënt met acuut leverfalen laat herkend en verwezen

Acute liver failure is often recognised too late, resulting in delayed referral of a patient in a very poor condition. In order to recognise it in the prodromal phase, when a patient presents with upper abdominal symptoms and fatigue, physicians should include acute liver disease in the differential diagnosis. They should be aware that potentially lethal complications such as brain oedema, sepsis, haemodynamic instability and renal and respiratory insufficiency can develop rapidly following the appearance of jaundice and encephalopathy. A 60-80% patient survival rate is possible only with prompt referral to a liver transplant centre and optimal intensive care, often followed by liver transplantation. Plasmapheresis or albumin dialysis may help to bridge the gap while the patient waits for transplantation, especially in Wilson disease. Other specific measures can be found in guidelines and protocols that can be accessed via Internet. Early recognition of acute liver failure is the key to prompt referral.

Conflict of interest: B. van Hoek is member of the medical advisory board at MSD, Janssen and Roche and receives grants from Janssen, Boehringer and Astellas. Financial support: none declared.