Shock Liver: Shock liver or ischemic hepatitis describes diffuse injury to the liver from an episode of acute hypoperfusion. Shock liver codes to K72.00 (Acute and subacute hepatic failure without coma) which is an MCC. While shock liver can be found in the alphabetical index for ICD-10 CM, ischemic hepatitis cannot. Therefore, a query opportunity may exist for documentation stating ischemic hepatitis to fully code this condition. Any form of sustained hypoperfusion, such as acute congestive heart failure can cause shock liver. Signs of hemodynamic instability are usually present before clinical signs of liver injury; the underlying hemodynamic instability is often the focus of treatment.

Symptoms: a patient is often asymptomatic and have mild jaundice or develop symptoms which mimic viral hepatitis such as anorexia, malaise, or RUQ pain. However, in viral hepatitis, there will not be a rise in the LDH.

Clinical criteria: the diagnosis of shock liver or ischemic hepatitis is derived from the biochemical profile of the liver function test. The typical picture consists of a massive rise in LDH, followed by a 25-250 increase above the upper levels of normal for the AST and ALT.

Treatment: is usually non-specific and supportive. Priority is correction of the hypoperfusion and continued monitoring of the liver function tests.

Consideration of this diagnosis would be in patients experiencing episodes of acute hypoperfusion to the internal organs and/or experiencing other types of shock. If there is an early rise in the LDH followed within 12-24 hours by a 25-fold, or greater, increase in AST and ALT (>1000) other potential conditions should be considered before querying the provider. If there is no evidence of viral hepatitis, no evidence of toxic ingestion or overdose, and no thrombus in the portal veins – then shock liver may be an additional diagnosis to consider

By Barb Brant, MPA, RN, CDIP, CCDS, CCS