Overview
Acute liver failure is a rapid loss of liver function, typically occurring within days or weeks, usually in individuals without preexisting liver disease. It is most commonly caused by hepatitis viruses or drug-induced liver injury, such as acetaminophen overdose. Symptoms may include yellowing of the skin and eyes (jaundice), upper right abdominal pain, swelling of the belly, nausea, vomiting, general malaise, disorientation, confusion, sleepiness, and breath with a musty or sweet odor. Acute liver failure is a medical emergency requiring hospitalization.
Understanding the disease
Symptoms
The symptoms of acute liver failure may include yellowing of the skin and eyeballs (jaundice), pain in the upper right abdomen, a swollen belly (ascites), nausea, vomiting, a general sense of feeling unwell (malaise), disorientation or confusion, sleepiness, tremors, and a musty or sweet odor in the breath. If you or someone you know experiences these symptoms, it is important to seek medical attention right away.
Risk Factors
Risk factors for developing acute liver failure may include:
- Viral hepatitis: Infections caused by hepatitis A, B, and C viruses can lead to acute liver failure.
- Medications and drugs: Certain medications, including acetaminophen (when taken in excessive amounts), and illegal drugs like acetaminophen can cause liver damage and result in acute liver failure.
- Alcohol consumption: Excessive alcohol consumption can lead to alcoholic liver disease and increase the risk of acute liver failure.
- Autoimmune diseases: Conditions like autoimmune hepatitis can cause the immune system to attack liver cells, leading to liver failure.
- Metabolic diseases: Rare metabolic diseases such as Wilson's disease and acute fatty liver of pregnancy can cause acute liver failure.
- Cancer: Liver cancer or other cancers that affect the liver can cause liver failure.
- Toxins and environmental factors: Exposure to certain toxins like carbon tetrachloride or the consumption of poisonous wild mushrooms can cause acute liver failure.
- Other medical conditions: Diseases affecting the veins in the liver (Budd-Chiari syndrome), shock, and heat stroke can contribute to acute liver failure.
- Herbal supplements: Certain herbal drugs and supplements, such as kava, ephedra, skullcap, and pennyroyal, have been linked to acute liver failure. It is essential to consult a healthcare professional for a proper evaluation and management of any potential risk factors for liver failure.
Development
Acute liver failure can develop in several ways, including:
- Viral hepatitis: Acute liver failure can be caused by viral infections such as hepatitis A, hepatitis B, or hepatitis C. These viruses can damage liver cells, leading to inflammation and loss of liver function.
- Drug-induced liver injury: Certain medications, including acetaminophen, can cause acute liver failure if taken in excessive amounts. Other drugs, such as antibiotics, anti-seizure medications, and herbal supplements, can also cause liver damage.
- Toxins and poisoning: Exposure to toxins like lead, arsenic, or pesticides can cause acute liver failure. Additionally, ingestion of poisonous mushrooms or other toxic substances can lead to liver damage and failure.
- Autoimmune liver disease: In some cases, the body's immune system mistakenly attacks liver cells, causing inflammation and liver damage. This can lead to acute liver failure.
- Inborn errors of metabolism: Rare genetic disorders can cause acute liver failure by impairing the liver's ability to process and eliminate waste and toxins.
- Acute fatty liver: This condition occurs when there is a rapid buildup of fat in the liver, leading to its dysfunction. This can be caused by certain medications, rapid weight loss, or other factors. In some cases, acute liver failure may have no obvious cause.
Assessment and Diagnosis
Triage
If you or someone you know suddenly develops symptoms such as yellowing of the eyes or skin (jaundice), tenderness in the upper abdomen, a swollen belly, nausea, vomiting, a general sense of feeling unwell (malaise), disorientation or confusion, sleepiness, tremors, or a musty or sweet odor in the breath, it is crucial to seek medical attention right away as acute liver failure is a life-threatening condition that requires immediate hospitalization.
Diagnosis
To diagnose acute liver failure, healthcare providers typically use a combination of blood tests, imaging tests, and examination of liver tissue. Blood tests can measure the liver's function and determine if blood clotting is affected. Imaging tests, such as ultrasound, CT scans, or MRIs, can help identify liver damage and potential causes. In some cases, a liver biopsy may be performed to collect a tissue sample for further examination.
Management and Treatment
Complications
Potential complications of acute liver failure include too much fluid in the brain (cerebral edema), bleeding and bleeding disorders, infections, and kidney failure. Infections are particularly common in the blood, respiratory, and urinary tracts. Acute liver failure can lead to serious outcomes and requires urgent medical attention.
Prevention
Acute liver failure can be prevented through taking care of your liver, reducing the risk factors, and following proper medical guidelines. Precautions include:
- Following instructions on medications: Be aware of the recommended dosage and don't exceed it. Notify your health care provider if you have liver disease or are taking other medications.
- Telling your provider about all medicines: Inform your healthcare provider about any over-the-counter and herbal medicines to prevent interactions with prescription drugs.
- Drinking alcohol in moderation: If you choose to drink alcohol, limit your intake to one drink a day for women and up to two drinks a day for men.
- Avoiding risky behavior: Refrain from using illicit intravenous drugs, sharing needles, and engaging in risky sexual activities. Ensure that tattoo and body piercing shops are clean and safe. By taking these precautions and being aware of the causes, such as acetaminophen overdose, prescription medications, and herbal supplements, you can help prevent acute liver failure.
Home Remedies
In cases of acute liver failure, it is crucial to seek medical attention promptly. Home remedies are not recommended as they may not address the underlying cause of the liver failure and could potentially worsen the condition. It is important to follow a healthcare provider's guidance and receive appropriate treatment, which may include hospitalization and, in some cases, a liver transplant.
Treatment
Treatment for acute liver failure depends on the underlying cause. In some cases, the liver function may return to normal with proper medical care and supportive treatment. However, in more severe cases, a liver transplant may be necessary. For acetaminophen overdose, treatment may involve activated charcoal to absorb the remaining toxin in the stomach and supportive care to manage symptoms. In some cases, a medication called N-acetylcysteine (NAC) may be given to help protect the liver and prevent liver damage. If the overdose is severe, a liver transplant may be needed. In cases caused by prescription medications, discontinuing the medication and providing supportive care may be sufficient. For viral hepatitis, treating the underlying infection may help resolve liver failure. In cases of autoimmune disease, immunosuppressive medications may be prescribed to reduce the immune system's attack on the liver. In all cases, prompt medical attention is crucial to prevent further liver damage and address complications.
Preparing for medical consultation
To prepare for an appointment for acute liver failure, you should:
- Write down any symptoms you're experiencing, including any that may seem unrelated to liver issues.
- Gather your medical history, including any major stresses or recent life changes.
- Make a list of all medications, vitamins, or supplements that you're taking.
- Bring results of any previous medical tests, including digital copies of imaging results or biopsy reports.
- Take a family member or friend along for support and to help recall important information discussed during the appointment.
- Prepare a list of questions to ask your doctor, such as:
- What is causing my acute liver failure?
- What tests do I need to confirm the diagnosis?
- What treatment options are available?
- What is the likely prognosis for my condition?
- Are there any lifestyle changes or medications I should consider to manage the condition? Remember to be open and honest with your doctor about your symptoms and medical history. This information will help them provide the best possible care and recommendations for your specific situation.