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Patients with acute hepatic failure who are potential transplant candidates should be promptly referred to a liver transplant center Clues to the diagnosis of acute liver failure due to Wilson disease include a low ALP and evidence of hemolysis Encephalopathy associated with acute liver failure predisposes to cerebral edema and responds less well to lactulose than that associated with chronic liver disease 23

In many cases, patients will begin to notice a decrease in pain or inflammation within a few days to a week after their first injection

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