Acute decompensated cirrhosis

§ Decomp. Chirrosis

• Jaundice
• Ascites
• Hepatic Encephalopathy
• Suspected Variceal Haemorrhage

¥ KDIGO

1. ↑creatinine ≥ 26 µmol/L in 48 hours or
2. ≥50% rise in creatinine over the last 7 days or
3. UO <0.5mls/kg/hr for > 6 hrs based on dry weight or
4. Clinically dehydrated

‡ Diagnostic ascitic tap

• Green needle, irrespective of clotting parameters
• Universal container bottles for fluid albumin, MCS (with WCC differential) and blood culture bottles (minimal 5mls each bottle) to maximise yield of diagnosis of SBP
• Human Albumin Solution (HAS): 20g of albumin in 100ml of 20%

£ Contraindications to Terlipressin

Absolute

• Hypersensitivity, pregnancy, acute respiratory distress/hypoxia, septic shock, Creatinine ≥442μmol/l

Relative

• Age>70, peripheral arterial disease, ↑ QTc, cardiac arrhythmia, uncontrolled ↑BP, ACS, Hx AMI

Alternative to Terlipressin:

• Octreotide: 50 micrograms bolus followed by 25-50micrograms/hr infusion
• Suspend Β blockers if Terlipressin/Octreotide commenced
• Stable patients: Routine administration of platelets, FFP, PCC and other products to correct haemostatic tests is not recommended outside of patients taking anticoagulants
• Unstable patients: Discuss with the upper GI bleed team ± Haematologist ± consider major haemorrhage protocol. Avoid FFP in portal hypertension. Critical care review