Acute liver failure is the lost of liver function that occurs very quickly – within days or weeks – generally in a person who has no pre-existing liver disease. Acute liver failure is much less common than chronic liver failure, which develops more slowly.
Acute liver failure is also known as fulminant hepatic failure. It can cause serious complications. These complications include: increasing pressure in the brain and excessive bleeding. Acute liver failure is a medical emergency requiring hospitalization.
Depending on the cause, acute liver failure can occasionally be reversed with treatment. In most situations though, a liver transplant might be the only cure.
The signs and symptoms of acute liver failure include:
- Pain in the upper right abdomen
- Yellowing of the eyeballs and skin (jaundice)
- Abdominal swelling
- A general sense of feeling unwell (malaise)
- Disorientation or confusion
When liver cells are significantly damaged and are no longer able to function, acute liver failure occurs.
Potential causes include:
- Acetaminophen overdose. Taking too much acetaminophen (Tylenol and others) is the most common cause of acute liver failure in the USA. Acute liver failure may occur after higher than recommended doses daily for several days, or after once large dose of acetaminophen.
- Prescription medications. There are some prescription medications including nonsteroidal anti-inflammatory drugs, antibiotics, and anticonvulsants that can cause acute liver failure.
- Herbal supplements. Herbal supplements such as kava, skullcap, pennyroyal, and ephedra have previously been linked to acute liver failure.
- Hepatitis and other viruses. Hepatitis A, B, and E can lead to acute liver failure. Other viruses that may cause acute liver failure include herpes simplex virus, Epstein-Barr virus, and cytomegalovirus.
- Toxins. There are toxins that may cause acute liver failure which includes the poisonous wild mushroom Amanita phalloides. This mushroom is sometimes mistaken for one which is safe to eat. Another toxin that can cause acute liver failure is carbon tetrachloride. This is an industrial chemical that is found in solvents for waxes, varnishes and other materials, and refrigerants.
- Autoimmune disease. Liver failure can sometimes be caused by autoimmune hepatitis – a disease where your immune system attacks liver cells causing injury and inflammation.
- Diseases of the veins in the liver. Budd-Chiari syndrome, as well as other vascular diseases, can cause blockages in the liver veins which could lead to acute liver failure.
- Metabolic disease. There are rare metabolic diseases, such as Wilson’s disease and acute fatty liver of pregnancy, can infrequently cause acute liver failure.
- Cancer. Cancer that either spreads to or originates in your liver may cause your liver to subsequently fail.
- Shock. Overwhelming infection (like sepsis) and shock may severely impair blood flow to the liver, causing liver failure.
There are several tests and procedures that are used in the diagnosis of acute liver failure.
These tests include:
- Blood tests. Blood tests will be done to determine how well your liver is working. A test called a prothrombin time test measures how long it takes your blood to clot. When you have acute liver failure, blood doesn’t clot as quickly as it is supposed to.
- Imaging tests. Your doctor could recommend an ultrasound exam to get a look at your liver. Such testing can show liver damage and help your doctor to figure out the cause of your liver problems. Your doctor can also recommend abdominal computerized tomograph (CT) scanning, or magnetic resonance imaging (MRI), to look at your blood vessels and liver. This test can look for certain causes of acute liver failure like Budd-Chiari syndrome or tumors. They could be used if your doctor thinks there is a problem and ultrasound testing is negative.
- Examination of liver tissue. There’s a chance your doctor will recommend removing a small piece of liver tissue (liver biopsy). This will help your doctor understand the root cause of why your liver is failing. Because people with acute liver failure are at risk of bleeding during biopsy, the doctor could perform a transjugular liver biopsy. A tiny incision is made on the right side of your neck vein. Then a catheter is passed into a neck vein, through your heart, and into a vein exiting your liver. Your doctor will then insert a needle through the catheter to retrieve a sample of the liver tissue.
People who have acute liver failure are often treated in the hospital’s intensive care unit, in a facility that can perform a liver transplant if necessary. Your doctor could try to treat the liver damage itself, but in most cases, treatment will involve controlling the complications to give your liver time to heal as well as using liver failure medications.
Treatments for acute liver failure may include:
- Liver failure medications to reverse poisoning. Acute liver failure that is caused by an acetaminophen overdose is treated with a medication. This medication is called acetylcysteine and can also help to treat other causes of acute liver failure. Mushroom and other poisonings can also be treated with liver failure medications that can reverse the effects of the toxin and may reduce liver damage.
- Liver transplant. When acute liver failure is irreversible, the only treatment option will likely be a liver transplant. When a liver transplant takes place, a surgeon removes your damaged liver and replaces it with a liver from a donor that is healthy.
Your doctor will also work to control the signs and symptoms you are experiencing and try to prevent complications that are caused by acute liver failure.
Your care could include:
- Relieving pressure caused by excess fluid in the brain. Acute liver failure can cause cerebral edema (excess fluid in the brain) which can increase pressure on your brain. Liver failure medications can help reduce the fluid buildup in the brain.
- Screening for infections. The medical team taking care of you will take urine and blood samples every once in a while to test for infection. If your doctor suspects that you may have an infection, you will receive liver disease medications in order to treat the infection.
- Preventing severe bleeding. There are liver disease medications that your doctor can give you to reduce your risk of bleeding. If you lose a significant amount of blood, your doctor may perform tests to find out the source of the blood loss. You might require blood transfusions.