Acute or Fulminant Liver Failure
Acute or fulminant liver failure is a rare condition that happens when your liver suddenly begins to lose its ability to function. The changes happen in less than 26 weeks in someone who doesn't have any pre-existing liver disease. It is signaled by changes in mental function due to the liver's inability to remove toxins from the blood, and by an increase in INR, a marker that measures the blood's ability to coagulate. This is frequently the immediate result of an overdose of medication or poisoning. Stages for acute liver failure include less than 7 days, 7-21 days, and 12 days to 26 weeks. Chronic liver failure happens over a long stretch of time.
If you have acute liver failure, you may first experience symptoms like fatigue, nausea, loss of appetite, discomfort on your right side, just below your ribs, and diarrhea. As the disease progresses, however, you may also become confused and extremely sleepy. Other symptoms include bruising or bleeding easily, itching, jaundice, vomiting blood, and a buildup of fluid in your abdomen.
Who’s at risk
Too much acetaminophen, a painkiller present in many over-the-counter and prescription medicine, causes the majority of cases of acute liver failure. Other major causes are viral hepatitis, autoimmune disease, other drug-induced liver injury, and lack of oxygen to the liver. Some cases have no known cause.
Liver failure is a serious condition that requires immediate medical attention. Your doctor will probably perform an initial evaluation to check for signs of viral or drug-induced hepatitis. These include jaundice, fatigue, and abdominal pain. Your doctor will also test your mental alertness. He or she will do a variety of blood, urine and radiologic (usually an ultrasound) tests.
Treatment for acute liver failure depends on the underlying cause. If you have viral hepatitis, you may be prescribed an antiviral medication. If your immune system is too active, you may be prescribed an immunosuppressive medication. If your doctor suspects you took too much acetaminophen within the past several hours, he or she will probably give you activated charcoal. This will help your body reduce the absorption of the medication in your gastrointestinal tract. N-acetylcysteine is a medicine that can help with an acetaminophen overdose. You can take this medicine either by mouth or through a vein. N-acetylcysteine also sometimes helps people with acute liver failure that was not caused by too much acetaminophen.
If viral hepatitis B is the cause of your acute liver failure, your doctor may give you one of several medicines called nucleos(t)ide analogs. These drugs work by stopping the virus from replicating. If autoimmune hepatitis is causing your liver failure, your doctor can treat you with steroids and possible azathioprine.
If your doctor cannot find the cause of your acute liver failure, he or she may order a liver biopsy. This will provide more information and help determine your course of treatment.
If treatment can’t get your liver functioning again, you may be a candidate for a liver transplant. Less than 5% of people with acute liver failure will need a liver transplant. Good candidates are strong enough for surgery and don’t have underlying cardiovascular disease, severe infection, or other diseases like cancer or AIDS. If your doctor approves you for a liver transplant, your name will be placed on a waiting list to receive a donated organ. People with the most urgent need are placed at the top of the list.
While you are waiting for a liver to become available, you may be able to undergo some therapies to keep you alive. However, the effectiveness of these treatments is unclear.
If you have acute liver failure, common complications include bacterial and fungal infection and low blood sugar. Swelling of the brain is another side effect of acute liver failure, and one of the most serious.
You can prevent some of the underlying causes of acute liver failure. To avoid acetaminophen overdose, always follow the directions on the label when taking a drug that contains acetaminophen. Talk with your pharmacist or doctor if you have any questions. Two grams per day is the limit for this medication. Do not take acetaminophen with alcohol. Many medications can cause liver failure or liver injury. Ask your doctor how testing your liver can be timed to make sure there is no injury to your liver from your medications.
You can reduce your risk of contracting viral hepatitis by avoiding contact with the blood or feces of an infected person. If you visit other countries, particularly developing nations, you should avoid the local tap water. Vaccines are available to prevent hepatitis A and B for all travelers. Hepatitis A and B vaccines are now recommended for all during childhood.
When to call the doctor
Acute liver failure can occur in as little as 48 hours. It’s important to seek medical treatment at the first signs of trouble. These may include fatigue, nausea, diarrhea, and discomfort in your right side, just below your ribs.
- Hanrahan, John, MD
- MMI board-certified, academically affiliated clinician