Overview

Acute liver failure is loss of liver function that occurs rapidly — in days or weeks — usually in a person who has no pre-existing liver disease. Acute liver failure is less common than chronic liver failure, which develops more slowly.

Acute liver failure, also known as fulminant hepatic failure, can cause serious complications, including excessive bleeding and increasing pressure in the brain. It's a medical emergency that requires hospitalization.

Depending on the cause, acute liver failure can sometimes be reversed with treatment. In many situations, though, a liver transplant may be the only cure.

Symptoms

Signs and symptoms of acute liver failure may include:

  • Yellowing of your skin and eyeballs (jaundice)
  • Pain in your upper right abdomen
  • Abdominal swelling
  • Nausea
  • Vomiting
  • A general sense of feeling unwell (malaise)
  • Disorientation or confusion
  • Sleepiness

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.

Causes

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.

Complications

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.

Prevention

Reduce your risk of acute liver failure by taking care of your liver.

  • Follow instructions on medications. If you take acetaminophen or other medications, check the package insert for the recommended dosage, and don't take more than that. If you already have liver disease, ask your doctor if it is safe to take any amount of acetaminophen.
  • Tell your doctor about all your medicines. Even over-the-counter and herbal medicines can interfere with prescription drugs you're taking.
  • Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day for women of all ages and men older than 65 and no more than two drinks a day for younger men.
  • Avoid risky behavior. Get help if you use illicit intravenous drugs. Don't share needles. Use condoms during sex. If you get tattoos or body piercings, make sure the shop you choose is clean and safe. Don't smoke.
  • Get vaccinated. If you have chronic liver disease, a history of any type of hepatitis infection or an increased risk of hepatitis, talk to your doctor about getting the hepatitis B vaccine. A vaccine also is available for hepatitis A.
  • Avoid contact with other people's blood and body fluids. Accidental needle sticks or improper cleanup of blood or body fluids can spread hepatitis viruses. Sharing razor blades or toothbrushes also can spread infection.
  • Don't eat wild mushrooms. It can be difficult to tell the difference between a poisonous mushroom and one that is safe to eat.
  • Take care with aerosol sprays. When you use an aerosol cleaner, make sure the room is ventilated, or wear a mask. Take similar protective measures when spraying insecticides, fungicides, paint and other toxic chemicals. Follow product instructions carefully.
  • Watch what gets on your skin. When using insecticides and other toxic chemicals, cover your skin with gloves, long sleeves, a hat and a mask.
  • Maintain a healthy weight. Obesity can cause a condition called nonalcoholic fatty liver disease, which may include fatty liver, hepatitis and cirrhosis.
Aug. 29, 2017
References
  1. Goldberg E, et al. Acute liver failure in adults: Etiology, clinical manifestations and diagnosis. http://www.uptodate.com/home. Accessed March 7, 2017.
  2. Goldberg E, et al. Acute liver failure in adults: Management and prognosis. http://www.uptodate.com/home. Accessed March 7, 2017.
  3. Liver wellness. American Liver Foundation. http://www.liverfoundation.org/education/downloads/. Accessed March 7, 2017.
  4. Ferri FF. Acute liver failure. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier; 2017. https://www.clinicalkey.com. Accessed March 7, 2017.
  5. Bernal W, et al. Acute liver failure. New England Journal of Medicine. 2013;369:2525.
  6. 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.
  7. Flamm SL, et al. American Gastroenterological Association Institute Guidelines for the Diagnosis and Management of Acute Liver Failure. Gastroenterology. 2017;152:644.
  8. Roy-Chowdhury N, et al. Hepatocyte transplantation. http://www.uptodate.com/home. Accessed March 24, 2017.
  9. Cooper DK, et al. Pig liver xenotransplantation: A review of progress toward the clinic. Transplantation. 2016;100:2039.
  10. 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.
  11. Yin M, et al. Distinguishing between hepatic inflammation and fibrosis with MR elastography. Radiology. In press. Accessed March 24, 2017.
  12. Carbon tetrachloride. Environmental Protection Agency. https://www.epa.gov/foia/carbon-tetrachlorideox-frequently-asked-question Accessed April 17, 2017.
  13. Picco M (expert opinion). Mayo Clinic, Rochester, Minn. April 17, 2017.
  14. Rajan E (expert opinion). Mayo Clinic, Rochester, Minn. April 17, 2017.