My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care at intensivecarehotline.com. We instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power and influence, even if you’re not a doctor or a nurse in intensive care, making sure your loved one always gets the best care and treatment.

Today’s question comes from Tiffany, and before I answer Tiffany’s question, I have worked in critical care nursing for over 25 years, in three different countries where I worked as a nurse manager for over five years, and I can very confidently say that we have saved many lives for our clients in intensive care.

Today I have a question from Tiffany who says: 

”Hi Patrik,

My brother is currently on life support and in acute liver failure. It came out of nowhere and within three days at the hospital, he was told his liver was failing. They could give him morphine to pass peacefully or try life support, but he didn’t recommend it. There has just been so much so fast. We would like some additional feedback. My brother is only 34 and while he had some drug and alcohol use, he was otherwise pretty healthy. What should we be asking the doctors right now?

From Tiffany.”

First, Tiffany, I want to acknowledge how terrifying this must be. Your 34-year-old brother went from seemingly healthy to on life support within three days. That is the nature of acute liver failure. It is one of the most rapid and life-threatening conditions in medicine, and it can be absolutely overwhelming for families.

Here is what I want you to know. You have every right to ask questions, seek second opinions, and advocate strongly for your brother. The fact that the doctor didn’t recommend life support doesn’t mean it is not worth pursuing, especially at such a young age of 34. Doctors can be wrong. Prognoses in the ICU are very uncertain. Families who advocate get better outcomes. Families who question and get access to medical records get better outcomes.

So, what is acute liver failure?

Acute liver failure is a rapid and severe loss of liver function that occurs in a person with no pre-existing liver disease. Within days, the liver can no longer perform its vital functions: filtering toxins from the blood, producing clotting factors, regulating blood sugar, and more.

Common causes include:

• Drug or alcohol toxicity, including paracetamol or acetaminophen overdose
• Viral hepatitis: Hepatitis A, B, or C
• Autoimmune hepatitis
• Wilson’s disease
• Ischemic hepatitis, also known as shock liver
• Unknown or cryptogenic causes

In Tiffany’s brother’s case, drug and alcohol has been flagged, but that doesn’t automatically mean the outcome is hopeless. The specific cause, the degree of liver damage, and the presence of complications are what really matters.

Why the doctor’s recommendation to let him go does not have to be the final word?

I want to address this directly. When a doctor says, “I don’t recommend life support,” families often interpret this as an absolute verdict. It is definitely not. It is one doctor’s clinical opinion, and at 34 years old, with the right treatment, acute liver failure can be reversed.

Here is the key. The liver is unique among organs in its capacity to regenerate. If the underlying cause can be treated and the patient is supported through the acute phase, the liver can recover. This is why the ICU is fighting to buy time, not just to prolong dying, but potentially to allow recovery.

You need to understand whether your brother is being assessed for liver transplantation. This is critical. Some patients with acute liver failure are listed urgently for transplant and survive with a new liver. If this has not been discussed with you, it absolutely needs to be.

Questions you must be asking the ICU team right now.

Here is your advocacy checklist, Tiffany. These are the questions I would be asking if this was my brother.

On diagnosis and cause:

• What is the confirmed cause of the liver failure?
• Has a full toxicology screen been done?
• Has a viral hepatitis panel been completed?
• Has Wilson’s disease been tested for, especially relevant in a young person?
• What does the liver biopsy show, or is one planned?

On prognosis and scoring:

• What is his King’s College criteria score? This is a validated tool used to predict prognosis in acute liver failure.
• What is his MELD score (Model for End-Stage Liver Disease)?
• What are his current liver function tests, International Normalized Ratio (INR), ammonia levels, and bilirubin trending?
• Is there evidence of hepatic encephalopathy, and at what grade?

On transplant assessment:

• Has he been referred to a liver transplant center for urgent assessment?
• Is he on the transplant waiting list, or has he been evaluated and declined?
• If declined, why?
• What is the nearest liver transplant center and can he be transferred on life support?

On treatment:

• What life support interventions is he currently on, ventilator, vasopressors, Continuous Renal Replacement Therapy (CRRT), dialysis?
• Is he receiving N-acetylcysteine (NAC)? This is used in certain causes of liver failure.
• What is the plan for the next 24 to 48 hours?
• What would indicate to you that the situation is improving or deteriorating?
• What are the specific criteria that would lead to withdrawal of treatment, and have those criteria been met?

On your brother’s wishes:

• Did your brother ever express a preference about life support verbally or in an advance care directive?
• What is his current level of consciousness?
• Can he communicate at all?

Getting access to all medical records is non-negotiable

One of the most important things you can do right now is request access to all of your brother’s medical records, every test result, every blood result, every clinical note, every imaging report, all of it.

Here is why this matters. You cannot ask the right questions or get a meaningful second opinion without the full clinical picture. Many families I speak to have been told, “There’s nothing more we can do,” and when I review the actual records with them, I find critical information that was either not fully explained or that opens the door for further treatment options.

Do not accept verbal summaries. Request the written documentation. In most countries, Australia, UK, U.S., Canada, under the Privacy Act, you have the right to access medical records on behalf of a family member who cannot speak for themselves, assuming you are the next of kin or medical power of attorney.

And let’s also now look at treatment options for acute liver failure in ICU. Here is a breakdown of the treatments your brother’s team should be considering or actively using.

Mechanical ventilation: If your brother cannot protect his airway or is in respiratory failure, mechanical ventilation via an endotracheal tube or tracheostomy buys time for the liver to recover or for a transplant to occur. This is not a futile intervention, it is life support in the truest sense.

Continuous Renal Replacement Therapy (CRRT): Acute kidney injury is extremely common in liver failure. CRRT is a form of dialysis that gently filters the blood continuously, managing fluid, toxins, and electrolyte balance. This is often a bridge therapy.

Vasopressors and hemodynamic support: Liver failure causes a profound inflammatory response. Vasopressors or inotropes such as noradrenaline (norepinephrine), adrenaline (epinephrine), vasopressin, dopamine, dobutamine, or milrinone are used to maintain blood pressure and perfuse vital organs including the brain and kidneys.

Treatment of hepatic encephalopathy: High ammonia levels cause cerebral edema and encephalopathy. Treatments include lactulose, rifaximin, and in severe cases, intracranial pressure monitoring and targeted ammonia reduction.

Urgent liver transplantation: This is potentially life-saving and must be on the table for a 34-year-old. The King’s College criteria and MELD score guide transplant listing decisions. Drug or alcohol use history may affect eligibility but does not automatically exclude someone, especially if the cause is acute rather than chronic.

Liver support devices: The Molecular Absorbent Recirculating System (MARS) is a liver support device that functions similarly to dialysis but targets liver-specific toxins like ammonia and bilirubin. It is used as a bridge to transplant or recovery, and availability varies by center.

Treating the underlying cause: If paracetamol toxicity is involved, N-acetylcysteine (NAC) is the antidote. If autoimmune hepatitis is the cause, steroids may be appropriate. Identifying and treating the cause is fundamental.

Why a second opinion could change everything?

At 34 years of age, your brother is very young. His body has reserves that an older person may not have. The fact that one doctor doesn’t recommend life support doesn’t mean every specialist in the country agrees with that assessment.

I strongly encourage you to request a formal second opinion from a liver specialist or hepatologist and from a liver transplant center if this has not already happened. Many families I work with have had dramatically different conversations with specialists compared to generalist ICU teams. Acute liver failure in a young person is absolutely one of those situations where pushing for specialist input is entirely justified.

Also, what could come out of this situation, Tiffany, is potentially long-term mechanical ventilation, and if that’s needed, home care might be an option.

Even if your brother’s recovery is prolonged or delayed, even if he cannot be weaned from the ventilator quickly, or requires a tracheostomy or needs ongoing respiratory support, the ICU is not the only option. My sister company, Intensive Care at Home at intensivecareathome.com, is specialized in home intensive care nursing support and is a provider for ventilator-dependent adults and children at home.

We have been operating since 2012 and are certified to ISO 9001:2015 and National Disability Insurance Scheme (NDIS) standards, and we are fully third-party accredited for Intensive Care at Home.

For patients who:

• Cannot be weaned off invasive or non-invasive ventilation in ICU
• Have a tracheostomy and need ongoing airway management
• Are clinically stable but not well enough to be completely independent
• Require long-term palliative care at home with nursing support

Home-based intensive care is a real, proven, and often superior alternative to remaining in hospital indefinitely. We operate mainly in Australia in all major capital cities and all regional and rural areas, but we are also helping families in the U.S., Canada, and the UK.

Going home with specialist intensive care nursing support keeps patients out of the ICU predictably and permanently. It restores quality of life, reduces infection risk, and in many cases costs significantly less than ongoing hospitalization, particularly through NDIS funding pathways and private health insurance funding pathways for eligible clients.

Learn more at intensivecareathome.com.

Tiffany, you are not alone in this. My team and I have helped hundreds, if not thousands, of families in the ICU in exactly the situation you are facing, overwhelmed, underinformed, feeling stripped of your rights, and being asked to make life and death decisions in a matter of days.

Here is how we help. We restore your rights because you haven’t been stripped of rights, you just don’t know how to exercise them. We:

• Review all of your brother’s medical records with you in a structured, plain language format
• Help you formulate the exact questions to ask the ICU team
• Join your family in a direct conversation with the ICU team, asking the hard clinical questions and advocating on your behalf
• Help you pursue a second opinion or specialist referral
• Guide you through the transplant assessment process
• Support you in understanding the prognosis and what the clinical numbers actually mean

Tiffany, and for anyone in a similar situation, here is what I want you to do right now:

• Immediately request copies of all medical records
• Write down every question from this article and bring it to your next meeting with the ICU team
• Ask specifically about liver transplant assessment and whether your loved one has been referred
• Book a consulting call with me at intensivecarehotline.com, call one of the numbers at the top of our website, or send an email to [email protected] so we can help you navigate this together

You are your loved one’s best advocate. Don’t stop asking questions.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. And I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section, where we have done client interviews.

 

And because our advice is absolutely life-changing, right? The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for, they don’t know what questions to ask, they don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. And that’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

And that’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. And when I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.  I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care, so, if, in case you have unanswered questions, if you need closure or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com. If you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all questions intensive care-related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. And all of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

And all of that you get at intensivecarehotline.com. Call us on one of the numbers at the top of our website or simply send us an email to support at intensivecarehotline.com with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivcarehotline.com and I will talk to you in a few days.

Take care.