A fictional 43-year-old with no known chronic liver disease develops jaundice, a rising INR, hypoglycaemia and subtle confusion after several days of excessive paracetamol exposure.
Listen for the assumption.
I planned to repeat the liver tests tomorrow before contacting a liver unit because the patient is still talking normally.
Which findings suggest the transfer window may already be narrowing?
Coagulopathy, hypoglycaemia and altered cognition in acute severe liver injury. We should escalate to critical care and discuss with a transplant unit early.
Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.
Go to the first decision ↓The picture develops.
- INR continues to rise
- Arterial lactate remains elevated after initial resuscitation
- The patient becomes intermittently drowsy
Commit before you reveal.
After you select an option, reveal the model reasoning and the consultant’s feedback.
Hear the senior team refine the plan.
The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.
I will clarify single versus staggered paracetamol exposure, prescribed and herbal drugs, viral risks and pregnancy where relevant.
Good. Trend cognition, glucose, INR, lactate, renal function and urine output closely, and plan a safe transfer before deterioration removes that option.
I will document the liver-unit advice, thresholds for renewed contact and the transfer decision owner.
What must remain explicit.
- Use current local toxicology and acute-liver-failure protocols.
- Discuss early with a specialist liver transplant unit.
- Monitor glucose, consciousness, coagulation, lactate and renal function closely.
Where reasoning fails.
- Waiting for deep encephalopathy
- Reporting isolated liver enzymes without trajectory
- Allowing referral to interrupt active stabilisation
Possible acute liver failure from [cause/timeline], with INR [trend], pH/lactate [trend], glucose [trend], renal function/urine output [details] and consciousness [trend]. Liver-unit advice and transfer status are [details].
What information would you prepare before the liver-unit call so the discussion changes management immediately?