Acute Liver Failure

What is Acute Liver Failure?

The liver is the second largest organ in the body. Acute liver failure is life-threatening and strikes fast. It may happen suddenly, without showing any symptoms and when most of the liver is damaged and irreparable. The two types of acute liver failure are:

  • Acute: Here, the liver functions stop in weeks or days, and most patients have no liver problems or diseases preceding this event. E.g., Drug overdoses, mushroom poisoning, too much Tylenol or acetaminophen.
  • Chronic: Here, liver failure/damage is over a long period of time and causes liver failure. E.g., Liver cirrhosis. It can happen due to the following reasons:

AFLD- Alcoholic fatty liver disease is the result of fat deposits in the liver due to alcoholism and obesity.

Alcoholic hepatitis occurs with scarring, inflammation, and fat deposits in the liver and can be found in 35% of heavy drinkers.

Alcoholic cirrhosis is the advanced form of liver cirrhosis and affects 10-20% of heavy drinkers as per the American Liver Foundation.

What are the cause of Liver Failure ?

Acute liver failure or fulminant hepatic failure can be caused by

  • Overdose of Acetaminophen.
  • Viruses like Epstein-Barr virus, Hepatitis A, B and E, the herpes simplex or cytomegalo viruses.
  • Reactions to herbal medications, certain medications, mushrooms (Ex: Amanita phalloides) etc.
  • Autoimmune Hepatitis.
  • Wilson’s disease or copper build up in the liver.
  • Acute fatty liver of pregnancy (Rare).
  • Septicemia or septic shock.
  • Budd Chiari syndrome blocking the liver blood vessels.
  • Industrial toxins ingestion (Ex: Carbon tetrachloride).

Chronic liver failure causes include:

  • Hepatitis B/C
  • Alcohol consumption leading to cirrhosis.
  • Genetic Hemochromatosis or iron build-up.

Other liver failure causes include:

  • Cirrhosis
  • Primary sclerosing cholangitis of the bile ducts mostly in young men.
  • Oxalosis meaning the kidneys can’t rid themselves of calcium oxalate crystals.
  • Antitrypsin deficiency Alpha-1 a genetic lung disease.
  • Liver cancer/ adenoma
  • Fatty liver disease
  • Alcoholic hepatitis
  • Cancers
  • Heat Stroke
  • Alagille syndrome a genetic disease with fewer bile ducts.
  • PBC- Primary biliary cholangitis
  • Galactosemia or intolerance to sugars like galactose.
  • LAL-D or Lysosomal acid lipase deficiency used to break down fats.
  • Unknown causes.
What are the Symptoms and Signs of Liver Failure ?

The liver failure symptoms are similar to liver diseases and may include some or all of the below.

  • Weakness and fatigue.
  • Weight loss without trying.
  • Lack of appetite.
  • Nausea.
  • Bruising /bleeding easily.
  • Swelling in abdomen (Ascites) and legs.
  • Yellowing of eyes and skin (jaundice).
  • Severe itching and daytime sleeping.
  • Nose bleeds, hair loss, clubbing of fingers.
  • White nails, spider veins showing below the skin and redness of palms.
  • Personality changes.
  • Loss of memory or concentration issues.

In women

  • Stopping of periods.
  • Lack of sex drive.

In Men

  • Lack of sex drive.
  • Shrinking of testicles.
  • Breasts development (Gynecomastia).

Other common acute liver failure symptoms noticed are:

  • Fever
  • Vomiting blood
  • Muscle cramps
  • Enlarged spleen and abdomen
  • Yellowish-brown urine
  • Bone diseases causing brittleness and fractures

Note: Midas Hospitals recommends that the acute liver failure symptoms are not to be self-diagnosed and need urgent medical help, a proper diagnosis, and treatment as recommended by a team of gastroenterologists and physicians.

How is liver failure diagnosed?

Procedures to detect acute liver failure disease include

Physical Exam: The doctor generally will check symptoms, alcohol consumption, medical history and medications taken. The physical examination of your belly may involve checking for pain, swelling and tenderness by applying hand pressure on the belly region.

Blood tests: to assess acute liver failure treatment and how much of the protein and amino acid tested for are present in the blood and should generally be low. The doctor may order tests like

  • Prothrombin clotting time
  • Anaemia, RBC, blood picture and haemoglobin levels.
  • ALT- Alanine transaminase and AST- Aspartate transaminase tests
  • Albumin test
  • Bilirubin levels
  • Creatinine level
  • Stool test of faecal occult blood test
  • Sodium levels

Imaging tests: Permit the doctor to see what happens to the liver and may include tests like:

  • Ultrasound
  • CT scans of the abdomen
  • MRI

Biopsy: A small tissue sample is used to detect cancers etc., through the neck’s transjugular vein.

Endoscopy: A camera in a small pipe is non-invasively used to see the GI tract and liver.

  • Acetylcysteine, when administered immediately, can reverse acute liver failure due to overdose of acetaminophen overdose, poisons, mushrooms etc.
  • If a virus is the cause of liver failure, it can be treated at a hospital, after which the liver often recovers on its own.

Surgery and liver transplantation are the only options of liver failure treatment if liver failure is due to cirrhosis or long-term damage.

What is the treatment for Liver Failure ?

The treatment, medications and care depend on the liver injury and underlying causes.

To protect the healthy liver cells, what can be done is:

  • Stop smoking/drinking right away.
  • Use condoms for sex.
  • Never share needles or experiment with herbal medications, wild mushrooms etc.
  • Ensure your tattoo procedures are sanitised and safe.
  • Obese people should lose weight.
  • If it is Hepatitis C or B, take the medications.
  • Strictly follow instructions and appointments with the doctor.
  • Eat sufficient proteins.
  • Get shots for Hepatitis A/B, pneumonia and flu.
  • Practice good hand hygiene and sanitation.
  • Ascites patients should not take aspirin, acetaminophen, or ibuprofen.
  • Drink sufficient fluids to prevent dehydration.
  • Use a high-calorie, high-protein diet with a healthy lifestyle.
  • Take diuretic and low-salt diets to help with ascites.
  • Speak to your doctor for medications for constipation.
What are the warning Signs of Liver Failure ?

Midas Hospitals suggests you consult a doctor urgently if you observe any of these symptoms:

  • Blood in the vomit (Hematemesis).
  • Blood clotting issues.
  • Coronary problems.
  • UTI or infections of the upper tract, pneumonia etc.
  • Jaundice symptoms of yellow eyes and skin.
  • Bloody stools or brownish urine.
  • Severe constipation, no micturation and impaired bowel movements. (Kidney issues)
  • Confusion, tiredness and daytime sleeping (Cerebral oedema symptoms)

Note: These conditions are serious, and if you notice them in your child Midas Hospitals recommends that you consult a doctor right away.


If you have any or all of the acute liver failure symptoms mentioned, approach the doctors in Midas Hospitals for liver function evaluation and treatment. Stick to the cessation of smoking and liquor to prevent further inflammation and never self-medicate.

Can acute liver failure be prevented?

The best chances are to avoid liver cirrhosis and hepatitis, which can cause liver failure.

Can kidney failure result in acute liver failure?

The vital organs work in synchronisation. Any diseases of the brain, heart, spleen, kidneys, etc., cause altered liver functions that can lead to liver failure.

Homosexual men can get HIV infections, and tattoos in unsanitary conditions can cause Hepatitis which leads to liver failure.

What are the chances of finding a donor for liver transplants?

Liver transplants generally have a wait-list, and if you do not have a healthy donor, you may have to wait for a cadaver or brain-dead donor’s liver.

Is daytime sleeping in normal persons a sign of liver failure?

Confusion, tiredness, sudden personality changes, daytime sleeping in normal persons etc., are liver failure causes/symptoms that must be evaluated urgently.