Patients with ALF characteristically have a high cardiac index (frequently >5 l/min/m 2) and a low systemic vascular resistance. The peripheral vasodilatation may result in hypotension but this is usually responsive to appropriate volume loading. If hypotension is not controlled by fluid replacement, inotrope infusions are indicated. However, hypertension may occur in patients with advanced encephalopathy, and is probably an appropriate response to maintain the cerebral perfusion pressure in response to an elevated intracranial pressure. In this circumstance, management of hypertension should involve assessment and treatment of the raised intracranial pressure. ^-Acetylcysteine improves tissue perfusion, oxygen extraction ratio, and mean arterial pressure in patients with ALF from various causes. Despite these potentially beneficial effects, its effect on outcome has yet to be evaluated.
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