Acute Liver failure

Rare causes of acute liver failure


Acute liver failure can happen to anyone! Acute Liver failure occurs suddenly. If liver damage develops over a long period of time we speak about chronic liver failure.
Here, we speak about Acute Liver Failure.

Acute liver failure is relatively rare (1-10 cases per million population per year) and is life-threatening. Acute liver failure is a loss of liver function that occurs rapidly – in days or weeks – usually in a person who has no pre-existing liver disease.
An acute liver failure occurs by severe damage to liver tissue and causes acute disruption of liver functions. There can be several reasons why it occurs. It’s a medical emergency that requires hospitalization.
Acute liver failure is not only distressing for the patient, but it can also be an anxious and uncertain time for family and friends.

The symptoms of acute liver failure
The symptoms include nausea, vomiting, abdominal pain and fatigue.
But also yellowing of the skin and eyeballs (jaundice), abdominal swelling (ascites), tremors, a general sense of feeling unwell (malaise), sleepiness, breath may have a musty or sweet odor and disorientation or confusion (Hepatic Encephalopathy)

Hepatic Encephalopathy is accompanied by neurological symptoms such as apathy, drowsiness and confusion. The patient may have seizures (convulsions) or go into a coma. There is also clotting disorder, jaundice, renal insufficiency and eventual loss of organ function.

Causes of acute liver failure
In adults, acute liver failure is mainly caused by:

- liver inflammation caused by viral hepatitis; by alcohol (alcoholic hepatitis) or by an autoimmune reaction (autoimmune hepatitis)
- liver damage caused by (prescription) drugs (paracetamol, antibiotics, analgetics) and/or toxic substances
- metabolic diseases (e.g. Wilson’s disease)
- Herbal drugs and supplements, including kava, ephedra, skullcap and pennyroyal, have been linked to acute liver failure
- poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for one that is safe to eat
- overwhelming infection (sepsis) and shock can severely impair blood flow to the liver, causing liver failure

Causes of acute liver failure in childhood vary by age and can be broadly categorized as infectious, immunologic, metabolic, and toxin- or drug-related. Viral hepatitis, particularly herpes simplex, is common in neonates, metabolic disease is more common in infants, and autoimmune hepatitis and acetaminophen toxicity are more common in older children. In recent years, modern molecular genetic methods have revealed new genetic causes of acute liver failure in children.

In 15-25 percent of cases in adults and up to 50 percent in children, no cause can be identified.


Very often the patient arrives very ill in the hospital and is often transferred directly to the intensive care unit.

Based on the symptoms and physical examination, the diagnosis of Acute Liver Failure can be considered. Blood tests will be done. If the test results show:
- elevated concentrations of liver enzymes and bilirubin and among other things
- abnormal blood clotting values
- the level of protein (albumin) in the blood is decreased and
- in addition, the level of ammonia (waste) in the blood increases.
Imaging of the liver (e.g. MRI, CT or ultrasound) can show liver abnormalities, an enlarged spleen and possibly ascites. Sometimes a liver biopsy is necessary. The microscopic examination of pieces of liver tissue (liver biopsy) may confirm the diagnosis.

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 often causes complications, including:
- excessive fluid in the brain (cerebral edema). Too much fluid causes pressure to build up in your brain, which can lead to disorientation, severe mental confusion and seizures.
- bleeding and bleeding disorders. A failing liver cannot make enough clotting factors, which help blood to clot. 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 liver failure.


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

Liver transplantation in acute liver failure
Very often the only way to recover is a liver transplantation. This is the last resort. Not all hospitals are a liver transplantation centre. That means that very often the patient had to be transferred to a specialized liver transplantation centre. If the patient is transferred, the doctors in that transplantation centre take over the care for the patient.

This is an exciting time for the patient, as well as for family and friends: a matching liver has to be waited for. Although the patient is very often too sick to have awareness about what is happening. Unfortunately, not all patients make it to the transplantation and die prematurely.