Clin Med
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ALF is a multisystem disorder necessitating both predictive and reactive management strategies to support and protect organs from the initial and subsequent insults encountered. Early referral to a specialist liver centre with the option of liver transplantation is recommended. Furthermore, a good understanding of the poor prognostic variables is necessary to determine those most at risk of developing ALF in order to facilitate timely, safe transfer and listing for liver transplantation.
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This lesson describes a patient who had a cardiac arrest during an episode of status epilepticus provoked by a first fit. This is an exceptional sequence of events and should lead to investigation for an underlying cause. Unsuspected cocaine abuse is common and may provoke prolonged status epilepticus, particularly if there is a low seizure threshold. A toxic screen should be undertaken in all patients presenting with unexplained status epilepticus even if abuse of illicit substances is denied.