Signs and symptoms of acute liver failure may include:
- Yellowing of your skin and eyeballs (jaundice)
- Pain in your upper right abdomen
- Abdominal swelling
- A general sense of feeling unwell (malaise)
- Disorientation or confusion
When to see a doctor
Acute liver failure can develop quickly in an otherwise healthy person, and it is life-threatening. If you or someone you know suddenly develops a yellowing of the eyes or skin; tenderness in the upper abdomen; or any unusual changes in mental state, personality or behavior, seek medical attention right away.
Acute liver failure occurs when liver cells are damaged significantly and are no longer able to function. Potential causes include:
Acetaminophen overdose. Taking too much acetaminophen (Tylenol, others) is the most common cause of acute liver failure in the United States. Acute liver failure can occur after one very large dose of acetaminophen, or after higher than recommended doses every day for several days.
If you or someone you know has taken an overdose of acetaminophen, seek medical attention as quickly as possible. Don't wait for the signs of liver failure.
- Prescription medications. Some prescription medications, including antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants, can cause acute liver failure.
- Herbal supplements. Herbal drugs 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 one that is safe to eat. Carbon tetrachloride is another toxin that can cause acute liver failure. 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 veins in the liver. 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, infrequently cause acute liver failure.
- Cancer. Cancer that either begins in or spreads to your liver can cause your liver to fail.
- Shock. Overwhelming infection (sepsis) and shock can severely impair blood flow to the liver, causing liver failure.
Many cases of acute liver failure have no apparent cause.
Acute liver failure often causes complications, including:
- Excessive fluid in the brain (cerebral edema). Too much fluid causes pressure to build up in your brain.
- Bleeding and bleeding disorders. A failing liver cannot make enough clotting factors, which help blood to clot. Bleeding in the gastrointestinal tract is common with this condition. It may be difficult to control.
- Infections. People with acute liver failure are more likely to develop infections, particularly in the blood and in the respiratory and urinary tracts.
- Kidney failure. Kidney failure often occurs after following liver failure, especially if you had an acetaminophen overdose, which damages both your liver and your kidneys.
Aug. 29, 2017
- Goldberg E, et al. Acute liver failure in adults: Etiology, clinical manifestations and diagnosis. http://www.uptodate.com/home. Accessed March 7, 2017.
- Goldberg E, et al. Acute liver failure in adults: Management and prognosis. http://www.uptodate.com/home. Accessed March 7, 2017.
- Liver wellness. American Liver Foundation. http://www.liverfoundation.org/education/downloads/. Accessed March 7, 2017.
- Ferri FF. Acute liver failure. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed March 7, 2017.
- Bernal W, et al. Acute liver failure. New England Journal of Medicine. 2013;369:2525.
- Bernsten A, et al., eds. Liver Failure. In: Oh's Intensive Care Manual, 7th ed. Philadelphia, Pa.: Elsevier; 2014. https://www.clinicalkey.com. Accessed April 26, 2017.
- Flamm SL, et al. American Gastroenterological Association Institute Guidelines for the Diagnosis and Management of Acute Liver Failure. Gastroenterology. 2017;152:644.
- Roy-Chowdhury N, et al. Hepatocyte transplantation. http://www.uptodate.com/home. Accessed March 24, 2017.
- Cooper DK, et al. Pig liver xenotransplantation: A review of progress toward the clinic. Transplantation. 2016;100:2039.
- Karvellas CJ, et al. Current evidence for extracorporeal liver support systems in acute liver failure and acute-on-chronic liver failure. Critical Care Clinics. 2016;32:439.
- Yin M, et al. Distinguishing between hepatic inflammation and fibrosis with MR elastography. Radiology. In press. Accessed March 24, 2017.
- Carbon tetrachloride. Environmental Protection Agency. https://www.epa.gov/foia/carbon-tetrachlorideox-frequently-asked-question Accessed April 17, 2017.
- Picco M (expert opinion). Mayo Clinic, Rochester, Minn. April 17, 2017.
- Rajan E (expert opinion). Mayo Clinic, Rochester, Minn. April 17, 2017.