Hepatology
Acute Liver Failure Treatment
A liver that stops over days in someone with no liver disease before it. A medical emergency, and one of the few situations where transplant is decided in hours.
A liver that stops over days in someone with no liver disease before it. A medical emergency, and one of the few situations where transplant is decided in hours.
At a glance
- In hospital
- 14 days
- Total stay
- 45 days
- Cost
- Quoted after clinical assessment
Acute liver failure is the sudden loss of liver function in a person who had no liver disease beforehand. It develops over days or a small number of weeks. That is what separates it from chronic liver failure, which takes months or years as healthy tissue is gradually replaced by scar — and the difference is not academic, because the sudden form is an emergency that is managed in intensive care from the moment it is recognised.
What causes it
Paracetamol overdose — acetaminophen — is the most frequent cause, and it is worth saying plainly that this includes accidental overdose as well as deliberate. Viral hepatitis, particularly B, is another. So are other medications and toxins, inherited metabolic disorders, and any circulatory failure severe enough to cut the liver's blood supply.
How it presents
Symptoms arrive quickly. Jaundice — the yellowing of skin and eyes — is the visible one. Alongside it come loss of appetite, a characteristic sweet or musty odour on the breath, and, most importantly, changes in mental state: confusion, disorientation, drowsiness. That last group is hepatic encephalopathy, and it is the feature that decides how urgently everything else happens. Severe cases bleed easily and have difficulty with movement and consciousness.
How it is assessed
History first — what was taken, how much, and when, because the answer changes the treatment immediately. Then blood tests and urine tests, and imaging of the abdomen. A liver biopsy may be done to establish how much damage there is, though in a bleeding patient that decision is weighed carefully.
Treatment, and the transplant decision
Care is supportive and intensive: intravenous fluids, close control of blood glucose and electrolytes, blood products where clotting has failed, and treatment aimed at reducing the toxins that drive encephalopathy. Where a specific antidote exists — as it does for paracetamol — it is given as early as possible, because its usefulness falls with every hour. The liver can regenerate, and in less severe cases it does, which is why supportive care is not merely holding the line. Where it does not, transplantation is the only remaining option, and it is assessed urgently rather than scheduled. If you are reading this about someone who is unwell now, this is not a condition to travel for — it is one to be treated wherever they are, and a second opinion can follow later.
This page is general information, not medical advice. Whether a procedure is right for you is a decision for a qualified clinician who has seen your reports.