Serum (arterial) lactate level: Often elevated
Hematemesis or melena: Due to upper gastrointestinal (GI) bleeding
Ascites: Potential for hepatic vein thrombosis with rapid development in the presence of fulminant hepatic failure accompanied by abdominal pain
Encephalopathy
Acetaminophen and acetaminophen-protein adducts levels
Serum phosphate level: May be low
Change in liver span: May be small due to hepatic necrosis or may be enlarged due to heart failure, viral hepatitis, or Budd-Chiari syndrome
Serum free copper and ceruloplasmin levels: Low levels with Wilson disease
Complete blood count: May reveal thrombocytopenia
Serum bilirubin level: Elevated
Liver function tests: Often elevated levels of aspartate aminotransferase (AST)/serum glutamic- oxaloacetic transaminase (SGOT), alanine aminotransferase (ALT)/serum glutamic-pyruvic transaminase (SGPT), alkaline phosphatase (ALP)
Cerebral edema: May lead to signs of increased intracranial pressure (ICP) (eg, papilledema, hypertension, bradycardia)
Right upper quadrant tenderness: Variably present
Jaundice: Often present but not always
Serum creatinine level: May be elevated
Coagulation studies: PT and/or international normalized ratio (INR)
Arterial blood gas: May reveal hypoxemia
Serum glucose level: May be dangerously low
Serum ammonia level: May be dramatically elevated (accuracy: arterial > venous level)
Hypotension and tachycardia: Due to reduced systemic vascular resistance
