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Acute Liver Failure

Acute liver failure can be caused due to an infection, drugs, or other factors. It is comparatively less common than chronic liver failure, but if it occurs, it can lead to much severe symptoms.


Acute liver failure refers to the rapid loss of liver functioning due to an underlying cause. Your liver gets damaged and begins to lose its normal functioning within a few days or weeks. It is also known as a fulminant hepatic failure. Acute liver failure can be caused due to an infection, drugs, or other factors. It is comparatively less common than chronic liver failure, but if it occurs, it can lead to much severe symptoms. Acute liver failure is a medical emergency and must be treated immediately before complications arise.



Viral infections can cause acute liver failure. These infections can be caused by viruses such as hepatitis A virus, hepatitis B virus, hepatitis E virus, herpes simplex virus, cytomegalovirus, and Epstein-Barr virus. Another common cause of acute liver failure is drug overdose. Paracetamol or acetaminophen can damage the liver tissues if taken too much at once or more than necessary every day. Some other medications, including antibiotics, NSAIDs, and anticonvulsant drugs, may also cause acute liver failure. Majority of these medications are metabolized by the liver, so an overdose can cause complications. Similarly, some herbal medicines may damage the liver tissues as well.

Few rare causes of acute liver failure include autoimmune hepatitis, Budd-Chiari syndrome, Wilson’s disease, septic shock, heatstroke, and liver cancer. Certain toxins such as carbon tetrachloride, which is present in refrigerants, varnishes, etc., can also affect your liver. In some cases, it is difficult to identify the exact cause of acute liver failure.


Risk Factors and Epidemiology

Drug toxicity is one of the leading reasons for acute liver failure. Excessive use of paracetamol or acetaminophen can put you at risk for this condition. Viral infections are another major risk factor, among which viral hepatitis is the most dangerous one. A family history of rare genetic diseases that affect your liver can also increase your risk. Alcohol consumption is usually associated with chronic liver disease, but excessive intake of alcohol in a short period may increase the risk of acute liver failure.

Acute liver failure can occur in any individual but is more common among adults of older age. According to research, around 1% to 2% of people with viral hepatitis suffer from acute liver failure. Acute liver failure is predominant in women compared to men.


Signs and Symptoms

The signs and symptoms of acute liver failure manifest within a few days or weeks. If the disease is of mild to moderate severity, you may experience nausea/vomiting, loss of appetite, fatigue, fever, or generalized weakness. As your liver continues to get damaged, the symptoms get worse. They include abdominal pain, jaundice, fluid buildup in the feet and around the abdomen, musty breath, tremors, confusion, drowsiness, memory loss, and difficulty performing cognitive tasks. In severe cases, it can lead to severe hypotension, sepsis, or hepatic encephalopathy.



Your doctor will require a brief history from you or your attendant to identify the possible cause of acute liver failure. If someone you know has ingested many tablets of paracetamol, immediate action will need to be taken without waiting for symptoms to appear. The conformational diagnosis of acute liver failure is made on the basis of multiple tests. These can include complete blood count (CBC), prothrombin time, liver function tests (LFTs), INR, hepatitis tests, and other suitable tests according to the suspected cause. Imaging tests are also done to visualize the extent of this disease. These can include CT scans, abdominal ultrasounds, and MRI. A liver biopsy can be done if there is a risk of liver cancer.


Differential Diagnosis

Acute liver failure should be differentiated from other conditions that can cause abdominal pain, jaundice, and hepatic encephalopathy. These may include acute hepatitis, hemolytic jaundice, or cholestatic jaundice. Differentiation needs to be made immediately on the basis of history, physical examination, and diagnostic tests.



The treatment for acute liver failure is often carried out in an intensive care unit (ICU). The purpose of treatment is to slow down the progression of this disease and give enough time to your liver to heal itself. Supportive treatment is given to reduce the risk of excessive bleeding and increased fluid buildup in the brain. If you have been poisoned with a drug or toxin, you will be given medications to reverse that toxicity. Intravenous fluids and nutritional support are given to reduce the chance of further complications. If the liver is unable to revive despite supportive measures, a liver transplant will be the last option to save your life.



Medications are given according to the underlying disease. In case of paracetamol overdose, acetylcysteine is given to treat its toxicity and reverse the damage done to the liver. If you have an active viral infection, suitable antivirals will be given in prescribed dosages. Mannitol can be used to reduce the risk of fluid accumulation in your brain.



The prognosis of a patient with acute liver failure depends upon the age of the patient, underlying cause, and severity of the disease. Immediate liver transplants can be vital in certain cases, which can lead to mortality if not done within the given time range.



Acute liver failure can be prevented by taking special precautions while taking over-the-counter medications. These medications, especially paracetamol, can cause liver damage if taken too much. Consult with your doctor if possible before taking any medication or herbal supplement. Avoid alcohol intake and maintain a healthy lifestyle to maximize the functioning of your liver. Avoid practices such as unprotected sex and sharing needles that can lead to viral hepatitis.

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