Acute liver failure is a rare and severe consequence of abrupt injury to the liver cells, and can evolve over days or weeks to a lethal outcome.
A variety of insults to liver cells result in a consistent pattern of rapid-onset elevation of liver enzymes, change in mental status, thrombocytopenia and coagulopathy .
The absence of existing liver disease distinguishes acute liver failure from decompensated cirrhosis or acute-on-chronic liver failure.
Causes of acute liver failure include
- Paracetamol toxicity
- Hepatic ischemia
- Acute Viral Hepatitis
- Autoimmune hepatitis
- Drug-induced liver injury from prescription drugs, and herbal and dietary supplements.
- Acute Hepatitis E in Pregnancy
- Herpes Simplex Hepatitis in immunocompromised patients
Diagnosis requires careful review of medications taken, and serological testing for possible viral exposure. Because of its rarity, acute liver failure has not been studied in large, randomized trials, and most treatment recommendations represent expert opinion.
Improvements in management have resulted in lower mortality, although liver transplantation, used in nearly 30% of patients with acute liver failure, still provides a life-saving alternative to medical management.1,2
For more information, please visit https://www.aasld.org/publications/practice-guidelines
- Stravitz RT, Lee WM. Acute liver failure. Lancet. 2019 Sep 7;394(10201):869-881. doi: 10.1016/S0140-6736(19)31894-X.PMID: 31498101 Review.
- John P Norvell 1, Andres T Blei, Borko D Jovanovic, Josh Levitsky. Herpes simplex virus hepatitis: an analysis of the published literature and institutional cases. Liver Transpl. 2007 Oct;13(10):1428-34. doi: 10.1002/lt.21250.
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