Acute liver failure is a loss of liver function that occurs quickly – over a few days or weeks – usually in a person who does not have pre-existing liver disease. It is most often caused by a hepatitis virus or drugs like acetaminophen. Acute liver failure is less common than chronic liver failure, which develops more slowly.
Acute liver failure, also called fulminant liver failure, can lead to serious complications, including excessive bleeding and increased pressure in the brain. It is a medical emergency that requires hospitalization.
Depending on the cause, acute liver failure can sometimes be reversed with treatment. In many situations, however, a liver transplant may be the only cure.
Signs and symptoms of acute liver failure can include:
- Yellowing of your skin and eyeballs (jaundice)
- Pain in the right upper abdomen
- Abdominal swelling (ascites)
- A general feeling of malaise (malaise)
- Disorientation or confusion
- The breath can have a musty or sweet odor
Acute liver failure occurs when liver cells are severely damaged and can no longer function. Potential causes include:
Overdose of acetaminophen. Taking too much acetaminophen (Tylenol, others) is the most common cause of acute liver failure in the United States. Outside of the United States, acetaminophen is known as paracetamol. Acute hepatic failure can occur after a very high dose of acetaminophen or after daily doses higher than recommended for several days.
If you or someone you know has an acetaminophen overdose, see a doctor as soon as possible. Treatment can prevent liver failure. Do not wait for signs of liver failure.
Prescription drugs. Some prescription drugs, including antibiotics, nonsteroidal anti-inflammatory drugs, and anticonvulsants, can cause acute liver failure.
Herbal supplements: Herbal medications and supplements, including kava, ephedra, skullcap, and pennyroyal, have been linked to acute liver failure.
Hepatitis and other viruses: Hepatitis A, hepatitis B and hepatitis E can cause acute liver failure. Other viruses that can cause acute liver failure include Epstein-Barr virus, cytomegalovirus, and herpes simplex virus.
Toxins. Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for a fungus that is safe to eat. Another toxin that can cause acute liver failure is carbon tetrachloride. It is an industrial chemical found in refrigerants and solvents for waxes, varnishes and other materials.
Autoimmune disease: Liver failure can be caused by autoimmune hepatitis – a disease in which your immune system attacks liver cells, causing inflammation and injury.
Diseases of the hepatic veins. Vascular diseases, such as Budd-Chiari syndrome, can cause blockages in the veins of the liver and lead to acute liver failure.
Metabolic disease: Rare metabolic diseases, such as Wilson’s disease and acute fatty liver of pregnancy, rarely cause acute liver failure.
Cancer. Cancer that starts or spreads in your liver can cause your liver to fail.
Shock: Overwhelming infection (sepsis) and shock can cause very strange blood flow to the liver, resulting in liver failure.
Heatstroke: Extreme physical activity in a hot environment can trigger acute liver failure.
Some cases of acute liver failure have no apparent cause.
Acute liver failure occurs quickly. Loss of liver function occurs within weeks or even days. It can happen suddenly with no symptoms.
Common in acute liver failure are toxins from mushrooms or overdoses that can result from ingesting too much paracetamol (Tylenol).
Chronic liver failure
Chronic liver failure develops more slowly than acute liver failure. It can take months or even years for you to show symptoms. Chronic liver failure is often the result of cirrhosis, which is usually caused by long-term alcohol consumption. Cirrhosis occurs when healthy liver tissue is replaced with scar tissue.
During chronic liver failure, your liver becomes inflamed. This inflammation leads to the formation of scar tissue over time. When your body replaces healthy tissue with scar tissue, your liver begins to fail.
There are three types of alcoholic liver failure:
Alcoholic fatty liver disease: Alcoholic fatty liver disease is the result of fat cells deposited in the liver. It generally affects those who drink a lot of alcohol and those who are obese.
Alcoholic hepatitis: Alcoholic hepatitis is characterized by fat cells in the liver, inflammation, and scarring. According to the American Liver Foundation, up to 35 percent of people who drink a lot will develop this condition.
Alcoholic cirrhosis: Alcoholic cirrhosis is considered to be the most advanced of the three types. The American Liver Foundation says 10 to 20 percent of people who drink heavily have some form of cirrhosis.
People with acute liver failure are often treated in the intensive care unit of a hospital in a facility that can perform a liver transplant, if necessary. Your doctor may try to treat the liver damage itself, but in many cases, treatment involves controlling complications and giving your liver time to heal.
Acute liver failure treatments may include:
Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose is treated with a medication called acetylcysteine. This medication may also help treat other causes of acute liver failure. Mushroom and other poisonings also may be treated with drugs that can reverse the effects of the toxin and may reduce liver damage.
Your doctor will also work to control signs and symptoms you’re experiencing and try to prevent complications caused by acute liver failure. Your care may include:
Relieving pressure caused by excess fluid in the brain. Cerebral edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the fluid buildup in your brain.
Liver transplant. When acute liver failure can’t be reversed, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes your damaged liver and replaces it with a healthy liver from a donor.
Screening for infections: Your medical team will take samples of your blood and urine every now and then to be tested for infection. If your doctor suspects that you have an infection, you’ll receive medications to treat the infection.
Preventing severe bleeding: Your doctor can give you medications to reduce the risk of bleeding. If you lose a lot of blood, your doctor may perform tests to find the source of the blood loss. You may require blood transfusions.
Providing nutritional support: If you’re unable to eat, you may need supplements to treat nutritional deficiencies.
Tests and procedures used to diagnose acute liver failure include:
Blood tests. Blood tests are done to determine how well your liver works. A prothrombin time test measures how long it takes your blood to clot. With acute liver failure, blood doesn’t clot as quickly as it should.
Imaging tests. Your doctor may recommend an ultrasound exam to look at your liver. Such testing may show liver damage and help your doctor determine the cause of your liver problems. Your doctor may also recommend abdominal computerized tomography (CT) scanning or magnetic resonance imaging (MRI) to look at your liver and blood vessels. These tests can look for certain causes of acute liver failure, such as Budd-Chiari syndrome or tumors. They may be used if your doctor suspects a problem and ultrasound testing is negative.
Examination of liver tissue. Your doctor may recommend removing a small piece of liver tissue (liver biopsy). Doing so may help your doctor understand why your liver is failing. Since people with acute liver failure are at risk of bleeding during biopsy, the doctor may perform a transjugular liver biopsy. The doctor makes a tiny incision on the right side of your neck, and then passes a thin tube (catheter) into a neck vein, through your heart and into a vein exiting your liver. Your doctor then inserts a needle through the catheter and retrieves a sample of liver tissue.
Treatment for acute liver failure depends on the underlying cause. If your healthcare professional thinks that you have taken too much acetaminophen, you will probably be given activated charcoal. Taking this medicine will help your body to reduce the amount of medicine that is absorbed into your gastrointestinal tract. Or you can take N-acetylcysteine. This medication can also help with acetaminophen overdose. You can take this medicine by mouth or intravenously. It is also sometimes useful for people with acute liver failure that was not caused by too much acetaminophen.
If viral hepatitis is the cause of your acute liver failure, your healthcare professional may prescribe certain medicines for you depending on the type of hepatitis you have. If you have autoimmune hepatitis, your healthcare professional may treat you with steroids.
If your healthcare professional cannot find the cause of your acute liver failure, you may need a liver biopsy. This test can give more information about your liver. It can also help your healthcare professional decide on treatment.
If treatment cannot get your liver back to working order, you may need a liver transplant. Good transplant candidates are strong enough for surgery. They do not have an underlying cardiovascular disease, serious infection, or other illnesses like AIDS. But people with controlled HIV can get a liver transplant. If you are approved for a liver transplant, your name will be placed on an organ donation waiting list. People with the most urgent need are put at the top of the list.
While you are waiting for a liver to become available, you may be able to have therapies to keep you alive. But the effectiveness of these treatments is unclear.
When to see the docter
Your doctor will ask you or your family questions to try to determine the cause of your acute liver failure. Your doctor may ask you:
- When did the symptoms start?
- What prescription drugs are you taking?
- What over-the-counter medications are you taking?
- What herbal supplements do you take?
- Are you using illegal drugs?
- Have you ever had liver problems?
- Have you been diagnosed with hepatitis or jaundice?
- Do you have a history of depression or suicidal thoughts?
- How much alcohol do you drink?
- Have you recently started taking any new medications?
- Are you taking acetaminophen? How many?
- Are liver problems present in your family?
However, it has been reported that the interval between the onset of acute liver damage (jaundice) and the onset of liver failure (encephalopathy with or without coagulopathy) in such patients between 4 weeks (Indian definition) 2 – 4 to 24 weeks