Approaches to the management of fulminant hepatic failure.

This discussion has concerned the management of fulminant hepatic failure with stage III or IV encephalopathy occurring in a patient with previously normal liver function. Basic medical management must include special attention to the metabolic, neurologic, hemorrhagic, and infectious complications common to this syndrome as well as aggressive supportive care. Because the mortality rate remains high in spite of these measures, a variety of other approaches to therapy continue to be evaluated. These include corticosteroid administration, exchange transfusion, plasmapheresis, and the development of extracorporeal hepatic support systems.