Acute liver failure: A syndrome caused by the sudden loss of liver function in a person without pre-existing liver disease – as evidenced by
Acute liver injury:
Acute on chronic liver failure:
Acute liver failure in patients with underlying chronic liver disease
Some definitions use the time from development of jaundice to development of encephalopathy to further categorise acute liver failure
Subacute liver failure
This can be challenging to recognise as the clinical and radiological changes (small liver, ascites and mild splenomegaly) can mimic cirrhosis. It should be considered and discussed with a transplant unit early if it is a possibility.
Patients with an acute liver injury or acute liver failure can deteriorate rapidly and should be closely monitored. They should be discussed early with a specialist transplant unit and there should be early involvement of the critical care team if appropriate.
The management will depend on the aetiology however general management principles are:
All patients with a significant acute liver injury should be considered for transfer to a liver transplant or tertiary care unit. ALF is a rare syndrome and the experience of specialised liver units is required to improve the outcomes for these patients.
Suggested criteria for referral to specialist units are as follows. Early discussion with specialist units is essential.
| Paracetamol ALF | Non-paracetamol ALF |
| Arterial pH <7.30 or HCO3 <18 | Arterial pH <7.30 or HCO3 <18 |
| INR >3.0 on day 2 (or >4.0 thereafter) | INR >1.8 |
| Oliguria and/or elevated Creatinine | Oliguria/renal failure or Na <130mmol/l |
| Altered level of consciousness | Encephalopathy, hypoglycaemia or metabolic acidosis |
| Hypoglycaemia | Bilirubin >300 µmol/l |
| Elevated lactate unresponsive to full resuscitation | Shrinking liver size |
Adapted from EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. Journal of Hepatology 2017; 66: 1047–1081
References
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Buku Haematology - Newcastle - United Kingdom
Owner contact email: bukuhaem@gmail.com
Buku Haematology (The Owner) records no personally identifiable data. The following usage data are collected by default by the host of our App, AppYourself GmbH. This data is then managed as per their privacy policy below.
Data will only be shared by AppYourself in accordance with their Privacy Policy.
Buku Haematology (owned by Buku Tech Ltd) retain none of this data. We can see our user traffic, country of access and modules accessed. Unique identifiers are generated for each user by the AppYourself system to show the number of times the App is accessed and which modules are viewed by individuals. No further information about the individual is given.
AppYourself privacy policy
We (Buku Haematology) have removed those elements that we have chosen not to include in the App (such as Facebook integration for example). Please contact privacy@appyourself.net if you have any questions about personal data storage.
Among the types of Personal Data that this Application collects, by itself or through third parties, there are: Cookies; Usage Data; various types of Data; unique device identifiers for advertising (Google Advertiser ID or IDFA, for example); Storage permission; geographic position.
Complete details on each type of Personal Data collected are provided in the dedicated sections of this privacy policy or by specific explanation texts displayed prior to the Data collection.
In some cases, the Data may be accessible to certain types of persons in charge, involved with the operation of this Application (administration, sales, marketing, legal, system administration) or external parties (such as third-party technical service providers, mail carriers, hosting providers, IT companies, communications agencies) appointed, if necessary, as Data Processors by the Owner. The updated list of these parties may be requested from the Owner at any time.
The Owner may process Personal Data relating to Users if one of the following applies:
In any case, the Owner will gladly help to clarify the specific legal basis that applies to the processing, and in particular whether the provision of Personal Data is a statutory or contractual requirement, or a requirement necessary to enter into a contract.
Personal Data shall be processed and stored for as long as required by the purpose they have been collected for.
The Owner records no personal data, and therefore usage data is the only data retained, and this is retained by AppYourself.
The Data concerning the User is collected for the following purposes: Analytics, Hosting and backend infrastructure, Data transfer outside the EU, Device permissions for Personal Data access, Displaying content from external platforms, Infrastructure monitoring, Registration and authentication, and Location-based interactions.
For specific information about the Personal Data used for each purpose, the User may refer to the section “Detailed information on the processing of Personal Data”.
Key facts about data control by AppYourself;
Personal Data is collected for the following purposes and using the following services:
The services contained in this section enable the Owner to monitor and analyze web traffic and can be used to keep track of User behavior.
Google Analytics for Firebase or Firebase Analytics is an analytics service provided by Google LLC.
Firebase Analytics may share Data with other tools provided by Firebase, such as Crash Reporting, Authentication, Remote Config or Notifications. The User may check this privacy policy to find a detailed explanation about the other tools used by the Owner.
This Application uses identifiers for mobile devices and technologies similar to cookies to run the Firebase Analytics service.
Users may opt-out of certain Firebase features through applicable device settings, such as the device advertising settings for mobile phones or by following the instructions in other Firebase related sections of this privacy policy, if available.
Personal Data processed: Cookies; unique device identifiers for advertising (Google Advertiser ID or IDFA, for example); Usage Data.
Place of processing: United States – Privacy Policy. Privacy Shield participant.
Any data collected by AppYourself is transferred in keeping with these statements.
The Google Firebase services used to store and transfer data provide HTTPS encryption during information transit. Data encryption is also provided for cloud data storage. See https://firebase.google.com/support/privacy#data_encryption for more information.
If this is the legal basis, the transfer of Personal Data from the EU or Switzerland to the US is carried out according to the EU - U.S. and Swiss - U.S. Privacy Shield.
The Google Firebase services used to store and transfer data provide HTTPS encryption during information transit. Data encryption is also provided for cloud data storage. See https://firebase.google.com/support/privacy#data_encryption for more information.
Personal Data processed: various types of Data.
If this is the legal basis, the transfer of Personal Data from the EU to third countries is carried out according to an adequacy decision of the European Commission.
Personal Data processed: various types of Data.
This Application requests certain permissions from Users that allow it to access the User's device Data as described below.
This Application requests certain permissions from Users that allow it to access the User's device Data as summarized here and described within this document.
Personal Data processed: Storage permission.
This type of service has the purpose of hosting Data and files that enable this Application to run and be distributed as well as to provide a ready-made infrastructure to run specific features or parts of this Application. Some of these services work through geographically distributed servers, making it difficult to determine the actual location where the Personal Data are stored.
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Personal Data processed: Usage Data; various types of Data as specified in the privacy policy of the service.
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Personal Data processed: Usage Data; various types of Data as specified in the privacy policy of the service.
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Firebase Realtime Database is a hosting and backend service provided by Google LLC.
Personal Data processed: Usage Data; various types of Data as specified in the privacy policy of the service.
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Firebase Cloud Storage is a hosting service provided by Google LLC.
Personal Data processed: Usage Data; various types of Data as specified in the privacy policy of the service.
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This type of service allows this Application to monitor the use and behavior of its components so its performance, operation, maintenance and troubleshooting can be improved.
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This type of service makes it possible to manage a database of email contacts, phone contacts or any other contact information to communicate with the User.
Firebase Cloud Messaging is a message sending service provided by Google, Inc. Firebase Cloud Messaging allows the Owner to send messages and notifications to Users across platforms such as Android, iOS, and the web. Messages can be sent to single devices, groups of devices, or specific topics or User segments.
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This Application may send push notifications to the User.
This Application may track Users by storing a unique identifier of their device, for analytics purposes or for storing Users' preferences.
Users may exercise certain rights regarding their Data processed by AppYourself.
In particular, Users have the right to do the following:
This Application uses Cookies and other Identifiers. To learn more, the User may consult the Cookie Policy.
The User's Personal Data may be used for legal purposes by the Owner in Court or in the stages leading to possible legal action arising from improper use of this Application or the related Services.
In addition to the information contained in this privacy policy, this Application may provide the User with additional and contextual information concerning particular Services or the collection and processing of Personal Data upon request.
For operation and maintenance purposes, this Application and any third-party services may collect files that record interaction with this Application (System logs) use other Personal Data (such as the IP Address) for this purpose.
More details concerning the collection or processing of Personal Data may be requested from the Owner at any time. Please see the contact information at the beginning of this document.
This Application does not support “Do Not Track” requests.
The Owner reserves the right to make changes to this privacy policy at any time by notifying its Users on this page and possibly within this Application and/or - as far as technically and legally feasible - sending a notice to Users via any contact information available to the Owner. It is strongly recommended to check this page often, referring to the date of the last modification listed at the bottom.
Any information that directly, indirectly, or in connection with other information — including a personal identification number — allows for the identification or identifiability of a natural person.
Information collected automatically through this Application (or third-party services employed in this Application), which can include: the IP addresses or domain names of the computers utilized by the Users who use this Application, the URI addresses (Uniform Resource Identifier), the time of the request, the method utilized to submit the request to the server, the size of the file received in response, the numerical code indicating the status of the server's answer (successful outcome, error, etc.), the country of origin, the features of the browser and the operating system utilized by the User, the various time details per visit (e.g., the time spent on each page within the Application) and the details about the path followed within the Application with special reference to the sequence of pages visited, and other parameters about the device operating system and/or the User's IT environment.
The individual using this Application who, unless otherwise specified, coincides with the Data Subject.
The natural person to whom the Personal Data refers.
The natural or legal person, public authority, agency or other body which processes Personal Data on behalf of the Controller, as described in this privacy policy.
The natural or legal person, public authority, agency or other body which, alone or jointly with others, determines the purposes and means of the processing of Personal Data, including the security measures concerning the operation and use of this Application. The Data Controller, unless otherwise specified, is the Owner of this Application.
The means by which the Personal Data of the User is collected and processed.
The service provided by this Application as described in the relative terms (if available) and on this site/application.
Unless otherwise specified, all references made within this document to the European Union include all current member states to the European Union and the European Economic Area.
Small sets of data stored in the User's device.
This privacy statement has been prepared based on provisions of multiple legislations, including Art. 13/14 of Regulation (EU) 2016/679 (General Data Protection Regulation).
This privacy policy relates solely to this Application, if not stated otherwise within this document.
Latest update: May 17, 2018
Cookies and other Identifiers consist of portions of code placed on the User’s device that assist the Owner in providing the Service according to the purposes described.
Some of the purposes for which Identifiers are used may also require the User's consent. Whenever consent is given, it can be freely withdrawn at any time following the instructions provided in this document.
This Application uses Cookies or other Identifiers to carry out activities that are strictly necessary for the operation or delivery of the Service and, therefore, do not require Users to consent. Users can disable such Identifiers by modifying their browser or device settings as described in more detail within this document, but this may affect core operational functions or result in the unavailability of the Service.
This Application uses Cookies or other Identifiers to provide a personalized user experience by improving the quality of preference management options, and by enabling interaction with external networks and platforms.
This Application uses Cookies or other Identifiers to measure traffic and analyze User behavior with the goal of improving the Service.
The services contained in this section enable the Owner to monitor and analyze web traffic and can be used to keep track of User behavior.
Google Analytics for Firebase or Firebase Analytics is an analytics service provided by Google LLC.
Firebase Analytics may share Data with other tools provided by Firebase, such as Crash Reporting, Authentication, Remote Config or Notifications. The User may check this privacy policy to find a detailed explanation about the other tools used by the Owner.
This Application uses identifiers for mobile devices and technologies similar to cookies to run the Firebase Analytics service.
Users may opt-out of certain Firebase features through applicable device settings, such as the device advertising settings for mobile phones or by following the instructions in other Firebase related sections of this privacy policy, if available.
Personal Data processed: Cookies, unique device identifiers for advertising (Google Advertiser ID or IDFA, for example) and Usage Data.
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Users can provide or withdraw consent to the use of Cookies and other Identifiers by setting their preferences within the cookie notice or by updating such preferences via the relevant consent-preferences widget accordingly, if available.
Additionally, Users can manage preferences regarding Identifiers directly from within their own device settings and prevent – for example – the storing of third-party Identifiers. It is also possible, via relevant browser or device features, to delete previously stored Identifiers, including those used to remember the User’s initial consent. Users can, for example, find information about how to manage Identifiers in the most commonly used browsers at the following addresses: Google Chrome, Mozilla Firefox, Apple Safari and Microsoft Internet Explorer.
With regard to any Identifiers stored by third parties, Users can manage their preferences and withdraw their consent by clicking the related opt-out link (where provided), by using the means indicated in the third party's privacy policy, or by contacting the third party.
Notwithstanding the above, Users are hereby informed that they may follow the instructions provided by YourOnlineChoices (EU), the Network Advertising Initiative (US) and the Digital Advertising Alliance (US), DAAC (Canada), DDAI (Japan) or other similar services. Such initiatives allow Users to select their tracking preferences for most of the advertising tools. The Owner thus recommends that Users make use of these resources in addition to the information provided in this document.
Buku Haematology - Newcastle - United Kingdom
Owner contact email: bukuhaem@gmail.com
Since the storing of third-party Cookies and other Identifiers through the services used within this Application cannot be technically controlled by the Owner, any specific references to Identifiers stored by third parties are to be considered indicative. In order to obtain complete information, the User is kindly requested to consult the privacy policies of the respective third-party services listed in this document.
Given the objective complexity surrounding technologies related to Cookies and other Identifiers, Users are encouraged to contact the Owner should they wish to receive any further information on the use of such Identifiers by this Application.
Any information that directly, indirectly, or in connection with other information — including a personal identification number — allows for the identification or identifiability of a natural person.
Information collected automatically through this Application (or third-party services employed in this Application), which can include: the IP addresses or domain names of the computers utilized by the Users who use this Application, the URI addresses (Uniform Resource Identifier), the time of the request, the method utilized to submit the request to the server, the size of the file received in response, the numerical code indicating the status of the server's answer (successful outcome, error, etc.), the country of origin, the features of the browser and the operating system utilized by the User, the various time details per visit (e.g., the time spent on each page within the Application) and the details about the path followed within the Application with special reference to the sequence of pages visited, and other parameters about the device operating system and/or the User's IT environment.
The individual using this Application who, unless otherwise specified, coincides with the Data Subject.
The natural person to whom the Personal Data refers.
The natural or legal person, public authority, agency or other body which processes Personal Data on behalf of the Controller, as described in this privacy policy.
The natural or legal person, public authority, agency or other body which, alone or jointly with others, determines the purposes and means of the processing of Personal Data, including the security measures concerning the operation and use of this Application. The Data Controller, unless otherwise specified, is the Owner of this Application.
The means by which the Personal Data of the User is collected and processed.
The service provided by this Application as described in the relative terms (if available) and on this site/application.
Unless otherwise specified, all references made within this document to the European Union include all current member states to the European Union and the European Economic Area.
Cookies are Identifiers consisting of small sets of data stored in the User's browser.
Any technology - including Cookies - that allows for the storing of information, or the accessing of already-stored information, on the User’s device.
This privacy statement has been prepared based on provisions of multiple legislations, including Art. 13/14 of Regulation (EU) 2016/679 (General Data Protection Regulation).
This privacy policy relates solely to this Application, if not stated otherwise within this document.