Acute Liver Failure

What is acute liver failure?

Acute liver failure is when the liver is damaged beyond repair and is no longer able to function properly. Acute liver failure can happen very quickly – within as little as 48 hours – and is a life-threatening condition that requires urgent medical care.

What does the liver do?

The liver is the second largest organ in the body. It sits under the diaphragm and lungs on the right. It is responsible for a number of essential functions in the body. It:

  • filters the blood
  • breaks down toxins such as drugs and alcohol
  • processes old blood cells
  • stores iron
  • helps maintain a normal blood sugar level
  • produces blood clotting factors
  • produces and maintains normal levels of protein in the blood
  • produces immune factors to help fight infection
  • breaks down fat and protein.

What causes acute liver failure?

Many things can cause acute liver failure.

These can be:

  • viral infections such as hepatitis A, B and E, Epstein-Barr virus, cytomegalovirus and herpes simplex virus
  • vascular diseases such as Budd-Chiari syndrome
  • rare metabolic diseases, such as Wilson's disease and acute fatty liver of pregnancy
  • cancer that begins in, or spreads to, the liver
    autoimmune hepatitis (when the the immune system attacks liver cells).

Drugs and supplements can also cause acute liver failure, including:

  • some prescription medications such as antibiotics, anti-inflammatory drugs and anti-convulsants
  • some herbal supplements such as kava, ephedra, skullcap and pennyroyal
  • an overdose of paracetamol taken either as a single large dose or over several days.

Some toxins, such as that in the poisonous wild mushroom, Amanita phalloides, can also cause liver failure.

Symptoms of acute liver failure

People first notice tiredness, loss of appetite, nausea, bruising and excessive bleeding, confusion, abdominal pain and swelling, and a yellow tinge to the whites of the eyeballs and skin (jaundice).
Over time, if the condition becomes worse and the liver continues to fail, other symptoms may develop, such as muscle wasting, fluid retention, and increased confusion that may progress to a coma.

What happens in Intensive Care?

Often people with liver failure can be treated in hospital without being admitted into an Intensive Care Unit (ICU). However someone with worsening symptoms, such as bleeding or a reduced level of consciousness, might be taken to the ICU for closer monitoring and support.

When someone with acute liver failure arrives in ICU, they may have:

  • their vital signs, such as heart rate and temperature, monitored and displayed on a bedside monitor
  • breathing assistance given via an oxygen mask, ventilator, or endotracheal tube (see Breathing support)
  • a urinary catheter inserted to drain and measure urine output
  • nutrition given via a nasogastric tube
  • medications given, such as as n-acetylcysteine to help the liver
  • blood tests done, to check essential blood factors and assess how severe the liver failure is
  • blood products given to help control bleeding.

See the Equipment page for more detail of the machines mentioned above.

Liver failure can lead to kidney failure, and sometimes the heart and lungs may also require support. If this happens, drugs may be given to help control blood pressure, and a dialysis machine used to do the work of the kidneys.

The liver is often able to repair and regenerate itself, and sometimes care need only be given until this has happened. However, sometimes the liver cannot heal itself. In such cases, specialists will carefully assess the situation, and if appropriate, a liver transplant may be recommended.

Useful links

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.