Episode 101: Acute Liver Failure: Differentials, Deterioration and Decisive Action

In this episode of the RCP Medicine Podcast, transplant hepatologist Dr Mhairi Donnelly joins gastroenterology trainee Dr Jennifer Tham to explore the high‑stakes world of acute liver failure.

Through a detailed case of a young woman presenting with severe transaminitis and paracetamol toxicity, Mhairi and Jennifer guide listeners through the crucial steps in recognising acute liver injury, identifying early markers of deterioration, and escalating care at the right time.

The discussion covers the most common causes of acute liver failure in the UK, how to interpret markedly raised transaminases, the role of NAC beyond confirmed paracetamol toxicity, the importance of monitoring lactate and INR trends, management of hepatic encephalopathy in acute liver failure, and how psychiatric assessment influences transplant suitability. A must‑listen for anyone managing acutely unwell medical patients or seeking to deepen their understanding of this life‑threatening condition.

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