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The urine of women with acute fatty liver is tea colored—very different from the urine of women with HELLP, Dr. Sibai said. A low fibrinogen level (below 300 mg/dL) is almost always only acute fatty liver, he added.

The altered texture of a fatty liver on CT image can also help distinguish these patients from those with HELLP syndrome, Dr. Sibai said.

Acute renal failure is common in women with acute fatty liver but not very common in HELLP. These women can also develop pulmonary edema, metabolic acidosis, and pancreatitis, Dr. Sibai said. “Acute fatty liver is a metabolic disorder; preeclampsia and HELLP are ischemic disorders. The problem with the baby is acidosis, not hypoxia, with acute fatty liver.”

HELLP syndrome (above) has ovelapping symptoms and laboratory findings similar to acute fatty liver.

The altered texture of a fatty liver on CT image can help distinguish these patients from those with HELLP. Photos courtesy Dr. Baha Sibai

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