Acute liver failure refers to a rapid loss of liver function, usually within days or weeks. This is most common in people who have no liver disease. Most commonly, it’s caused by drugs such as acetaminophen or the hepatitis virus. Chronic liver disease, which is more common, causes acute liver failure less often than chronic liver disease.
Acute liver disease, also called fulminant or biliary failure, can lead to serious complications such as excessive bleeding and high blood pressure. This is a serious medical emergency that should be treated immediately.
Acute liver failure can sometimes be reversed depending on the cause. A liver transplant is sometimes the only option.
Acute liver failure can be characterized by:
- Jaundice is a yellowing of the skin and eyes.
- Pain in your upper right stomach
- Abdominal swelling (ascites).
- Feeling unwell or feeling sick (malaise).
- Confusion or disorientation
- A musty or sweet smell may be present in the breath.
When should you see a doctor?
Even in a healthy person, acute liver failure can quickly develop and could prove to be life-threatening. You should seek immediate medical attention if you notice a sudden yellowing of the skin or eyes; tenderness in your upper abdomen; unusual mental changes, personality, or behavior.
Acute liver failure is a condition in which the liver cells become damaged and no longer function properly. There are several possible causes.
- Acetaminophen abuse. Acetaminophen overdose (Tylenol and others) is the leading cause of acute liver disease in the United States. Paracetamol is the name for acetaminophen outside of the United States. Acute liver disease can develop after a single large dose of Acetaminophen or higher than the recommended daily doses for several days. Treatment may prevent liver failure. Do not wait to see the symptoms of liver failure.
- Prescription medication. Acute liver failure can be caused by prescription medications such as antibiotics, nonsteroidal anti-inflammatory drugs, and anticonvulsants.
- Herbal supplements. Acute liver failure has been linked to herbal drugs and supplements such as pennyroyal, ephedra, and skullcap.
- Hepatitis A, hepatitis B, and hepatitis E can cause acute liver failure. Acute liver failure can be caused by hepatitis A, Hepatitis B, and hepatitis E. Acute liver failure can also be caused by Epstein-Barr virus and cytomegalovirus.
- Toxins. Toxins can cause acute liver disease. Another toxin that can lead to acute liver failure is carbon tetrachloride. It is an industrial chemical that can be found in refrigerants, solvents for waxes and varnishes, and other materials.
- Autoimmune disease. Autoimmune hepatitis can lead to liver failure. This is a condition in which the immune system attacks liver cells and causes inflammation and injury.
- Vascular diseases in the liver. Vascular diseases such as Budd Chiari syndrome can lead to blockages in the veins and acute liver failure.
- Metabolic disease. Rare metabolic diseases such as Wilson’s and the acute fatty liver of pregnancy can cause severe liver disease.
- Cancer. Your liver may fail if cancer spreads or begins in your liver.
- Shock. Shock can cause liver failure if there is an overwhelming infection.
- Heatstroke. Acute liver failure can be caused by extreme physical activity in a hot climate.
Sometimes, acute liver failure is not due to any obvious cause.
Many complications can result from acute liver failure, such as:
- Cerebral fluid buildup (cerebral embolism) can lead to excess fluid in the brain. Excessive fluid in the brain can cause pressure to build up, which can lead a person to become disorientated, have severe mental confusion, or even seizures.
- Bleeding and bleeding disorders. A failing liver can’t produce enough clotting factors which allow blood to clot. This condition is known to cause bleeding in the gastrointestinal tract. This condition can be hard to manage.
- Infections. Acute liver failure patients are more susceptible to infections, especially in the blood and the respiratory and urinary systems.
- Kidney failure. Kidney failure is a common outcome of liver failure. This is especially true if you have taken acetaminophen too often, which can cause liver damage and kidney failure.
Take care of your liver to reduce your chance of developing acute liver failure.
- Follow the instructions for medications. Check the label insert to see the recommended dosage for any medication you are taking, such as acetaminophen. Don’t exceed that amount. Ask your doctor if you have liver disease.
- Inform your doctor about any medications you take. Prescription drugs can be affected by even over-the-counter or herbal medications.
- If you must drink alcohol, do so in moderation. Moderation is the key to enjoying alcohol. Healthy adults can have up to one drink per day for women, and two for men.
- Avoid dangerous behavior. If you are using illicit intravenous drugs, get help. Do not share needles. Condoms are not recommended for use during sex. Make sure you are safe and clean when you have tattoos done on your body. Don’t smoke.
- Get vaccinated. Talk to your doctor if you have a history of hepatitis B infection, chronic liver disease, or a higher risk of developing it. A vaccine is also available for hepatitis A.
- Avoid contact with the blood or body fluids of others. Hepatitis virus spreads easily through accidental needle sticks and improperly cleaned blood and body fluids. Infection can also be spread by sharing razor blades and toothbrushes.
- Wild mushrooms should not be eaten. It can be hard to distinguish between poisonous and safe mushrooms.
- Aerosol sprays can be dangerous. Use an aerosol cleaner in a well-ventilated area. Similar precautions should be taken when spraying fungicides, insecticides, paints, or other toxic chemicals. Always read the label.
- Pay attention to what you get on your skin. Protect your skin from insecticides and other harmful chemicals by wearing gloves, long sleeves, a mask, and a hat.
- Keep your weight under control. Nonalcoholic fatty liver disease (NAFLD) can be caused by obesity. This condition may include fatty liver, liver damage, and cirrhosis.
The following tests and procedures are used to diagnose the acute liver disease:
- Blood tests. These tests measure the health of your liver. The prothrombin time test is a measure of how long your blood takes to clot. Acute liver failure can cause blood to not clot as fast as it should.
- Ultrasound tests. To examine your liver, your doctor might recommend it. This testing can help determine the cause of liver disease and may be used to detect liver damage. To examine your liver and blood vessels, your doctor may recommend either an abdominal computerized tomography scan (CT) or magnetic resonance imaging(MRI). These tests can be used to check for tumors or Budd-Chiari syndrome, which are some of the causes of acute liver disease. If your doctor suspects that there is a problem, and the ultrasound test is negative, these tests may be used.
- Exam of the liver tissue. A liver biopsy may be recommended by your doctor. This may help your doctor to understand the cause of your liver problems. A transjugular liver biopsy may be performed because people suffering from acute liver failure are more at risk of bleeding during the procedure. A doctor will make a small incision on your right side. Then, he or she will pass a thin tube (catheter), through the neck vein and into the vein that exits your liver. The doctor will then insert a needle into the catheter to retrieve a sample from your liver.
Acute liver failure patients are usually treated in an intensive care unit at a hospital. This facility can also perform a liver transplant if needed. Although your doctor might attempt to treat the liver damage, in most cases treatment is about managing complications and allowing your liver to heal.
The following are possible treatments for acute liver failure:
- Treatments to reverse poisoning. Acetylcysteine is used to treat acute liver failure due to acetaminophen excess. This medication can also be used to treat other types of acute liver disease. Other poisonings, such as mushrooms, can also be treated with drugs that may reverse the effects of the toxin or reduce liver damage. Habbe Kabid Naushadri is a carminative, digestive, and liver tonic. Your doctor will help you manage any symptoms and prevent complications from acute liver failure. The following may be included in your care:
- Treating excess fluid buildup in the brain. This is a way to relieve pressure. Acute liver failure can cause cerebral edema. Your brain fluid buildup can be reduced with medications.
- Liver transplant. If acute liver failure is not treatable, a liver transplant may be the only option. A surgeon will remove your damaged liver and transplant it to a healthy donor.
- Infection screening. Every now and again, your medical team will collect samples from your blood and urine to test for infection. Your doctor will prescribe medication to treat any infection he suspects.
- Avoiding severe bleeding. Your doctor may prescribe medications to lower the chance of your bleeding. Your doctor might perform tests to determine the cause of your blood loss. Transfusions may be required.
- Providing nutritional assistance. Supplements may be necessary if you are unable to eat.
Researchers continue to investigate new treatments for acute liver disease, particularly those that can delay or reduce the need for liver transplants. Although there are many potential future treatments in development, it is important to keep in mind that they may not be yet available.
These are some of the subjects being studied:
- Artificial hepatic assist devices. A machine would perform the work of the liver in the same way that dialysis is used to help the kidneys fail. Many different devices are being investigated. Some devices, but not all, may increase survival. One system, extracorporeal liver support, was shown to be effective in helping people with acute liver failure to survive without transplants. This was demonstrated by a well-controlled multicenter study. This treatment is also known as high-volume plasma exchanging. This therapy is still in development.
- Hepatocyte transplantation. The need for a liver transplant may be delayed temporarily if the liver is only being transplanted with the cells. It may lead to complete recovery in some cases. This treatment is not available due to a shortage of donor livers of high quality.
- Auxiliary liver transplantation. This involves the removal of a small portion of your liver and replacement with a similar-sized graft. This allows your liver to heal itself without the use of immunosuppressant medications. Auxiliary liver transplantation can be a complicated procedure and requires more time to evaluate.
- Xenotransplantation. This transplant replaces the liver of a human being with one from an animal or another non-human source. Many decades ago, doctors tried experimental liver transplants with pig livers. The results were not satisfactory. Researchers are now considering this treatment again due to improvements in transplant medicine and the immune system. It could be a support option for people who are waiting for a human transplant.