Cirrhosis in the ICU Patient
Brigid McGraw & Elizabeth Sullivan
Conway School of Nursing, NURS481 Practicum
April 27th, 2026
Cirrhosis, scarring of the liver, is end stage liver disease caused by repeated injury to the liver that hinders cirulation to other body systems
Nursing Intervention 1: Monitoring Hemodynamics
- Splanchnic vasodilation → RAAS → fluid retention in abdomen → increasing hepatorenal syndrome/hypovolemia.
- Hemodynamic monitoring allows the nurse to quickly detect signs of deterioration.
Nursing Intervention 2: Fluid and Electrolyte Management
- RASS → ADH → fluid retention → dilutional hyponatremia
- monitoring measures of fluid volume and serum electrolytes track worsening fluid accumulation
Nursing Intevervention 3: Mental Status
- Ammonia accumulation → hepatic enephalopathy
- Using CAM-ICU/GCS the nurse can monitor neuro toxicity as ammonia levels may not reflect severity alone.
References
Ballester, M. (2026, March). Ammonia measurement in cirrhosis: International Delphi consensus recommendations from ISHEN. ScienceDirect. https://doi.org/10.1016/j.jhep.2026.03.020
Crihan, M. (2025, March 19). Continuous non-invasive hemodynamic monitoring in cirrhotic patients-friend or Foe?. Medicina (Kaunas, Lithuania). https://pmc.ncbi.nlm.nih.gov/articles/PMC11943466/
Fabrellas, N. (2021, March). Nursing care of patients with cirrhosis: The Liverhope Nursing Project. Hepatology (Baltimore, Md.). https://pmc.ncbi.nlm.nih.gov/articles/PMC7154704/
- End stage liver disease
- Chronic injury to liver → fibrosis (scarring) and nodule regeneratoion → distorted architecuture of liver
- Impeded blood flow leads to portal hypertension
Iirreversible damage
- Prominent Health Information
- Patient is a 61 y/o M, presented to the ED with ruptured esophageal varcies, requiring intubation and mechanical ventilation for airway protection and stabilization.
- Patient has a PMH of hypertension, cirrhosis, ascities, and edema. AMS is consistenet with hepatic encephalopathy.
- Relevant History
- Patient abuses alchohol, which is the primary cause of the cirrhosis.
- Additonally patient had progressive symptoms of fatigue, abdominal pain and distrention prior to admission.
- Patient’s response to interventions
- Patients oxygenation was maintained. Hemodynamic support via a-line and transfusions therapy helped imporve ciruclatory stability.
- Ascities and edema showed minal improvement with diuretics.
- AMS was present, monitored through CAM-ICU, though lactulsoe therapy was initiated to reduce ammonia levels, which patient responded well to.
- Prominent Health Information
- Patient is 61 y/o M who presented to outside ED with decompensated alcoholic cirrhosis. Transferred to MGUH d/t septic shock, HRS needing CRRT, and a transplant evaluation
- Patient’s complications include HE, HRS, ascites, and varices.
- Relevant History
- Patient abused alcohol. Unsure of how long he has not had a alcoholic beverage.
- Patient also has a history of arthritis.
- Patient’s response to interventions
- Patient’s hemodynamic stability was maintained through constant monitoring via an A-line and medications like midodrine and droxidopa. This supported perfusion of organs.
- Patient’s electrolyte levels and fluid balance goal was met via CRRT. Creatinine and BUN were unfortunately not WNL by end of shift.
- Patient’s AMS was monitored via CAM-ICU assessments and ammonia levels. Mental status improved throughout shift with lactulose therapy. Patient met the goal of having 2-3 stools/shift and ammonia levels improved.
- RUQ pain
- Jaundice
- ↑ AST & ALT
- ↑ PT & INR
- ↓ albumin
- Spider angioedema
Impact on Other Body Systems
- Hematologic: Thrombocytopenia, leukopenia, anemia, coagulopathies
- Renal: hepatorenal syndrome (pre-renal kidney failure)
- Ascites & peripheral edema due to decreased colloid pressure
- Portal hypertension and varices
- Most common with HCV, NASH, alcohol abuse
- Increased severity of disease progression with continued alcohol use