Acute Liver Failure

Acute liver failure is a rare condition in which the liver rapidly deteriorates and stops functioning within a matter of days. Because it can develop so quickly, often in people with no pre-existing liver disease, it is considered a life-threatening condition.

Key Facts

  • While other liver conditions take months or years to destroy the liver, acute liver failure takes only days.
  • It can be caused by overdosing on medication or ingesting toxic substances, and often affects those with no pre-existing liver conditions.
  • Medications can treat acute liver failure caused by overdoses and toxins. In all other cases, a liver transplantation will be required.


The following are some of the most common causes of acute liver failure:

  • Acetaminophen: Overdosing on acetaminophen (such as Tylenol) is the most common cause of acute liver failure in the U.S.
  • Cancer: Cancer that begins or spreads to the liver can cause acute liver failure.
  • Herbal Medications: Common herbs such as aloe vera, chaparral, comfrey, ephedra, and kava can be toxic to the liver.
  • Hepatitis: In rare cases, hepatitis A, B, and E, as well as autoimmune hepatitis, can all cause acute liver failure. When this is the case, it is called fulminant hepatitis.
  • Metabolic Diseases: Rare conditions such as Wilson’s disease can cause acute liver failure.
  • Prescription Medications: Drug-induced acute liver failure can be caused by various medications, such as antibiotics, nonsteroidal anti-inflammatories, and anticonvulsants.
  • Toxins: Poisonous mushrooms are the most common toxin to cause acute liver failure.
  • Vascular Diseases: These include Budd-Chiari syndrome, which can block the veins in the liver.


The following are some of the most common symptoms of acute liver failure:

  • Abdominal pain
  • Disorientation, confusion, and/or an inability to concentrate
  • General malaise
  • Jaundice (yellowing of skin and eyes)
  • Nausea
  • Sleepiness
  • Vomiting

Because many of these symptoms can be associated with other conditions, it can be difficult to detect signs of acute liver failure. However, if you develop jaundice, abdominal pain, or unusual changes in your mental state, go to a doctor immediately. Acute liver failure can develop quickly and can be fatal.


The following are the most common ways to diagnose acute liver failure:

  • Blood Tests: These will determine how well the liver is functioning. A prothrombin time test, which measures how long it takes blood to clot, is the most common exam. Other tests may measure levels of bilirubin, albumin, lactate (lactic acid), and phosphate.
  • Imaging Tests: This will usually include an ultrasound, which uses soundwaves to form an image of the liver so that doctors can detect liver damage. Other tests may include a computerized tomography (CT) scan and magnetic resonance imaging (MRI). Both help doctors look for other causes of acute liver failure when the ultrasound is negative.
  • Liver Biopsy: This is a surgical procedure that removes a tiny portion of liver tissue so that doctors can examine it under a microscope to determine what is wrong.

In addition to these tests, doctors may also ask about recent symptoms, medications, and factors that put the patient at risk of viral hepatitis, such as intravenous drug use and tattoos.


Depending on its cause, there are two forms of treatment for acute liver failure: medication and transplantation. Because acute liver failure can develop so quickly and is fatal, it is vital to seek treatment immediately.


When acute liver failure is caused by ingesting toxic substances, acetaminophen overdose, or viral hepatitis, it can often be treated through medication. These include the following:

  • Activated Charcoal: This is carbon that has been exposed to high temperatures, which increases its surface area and makes it effective at absorbing toxins.
  • Antiviral Therapy: This encompasses a variety of medications that will slow down the effects of the hepatitis virus. They may include entecavir (Baraclude), tenofovir (Viread), lamivudine (Epivir), adefovir (Hepsera), and telbivudine (Tyzeka).
  • N-Acetyl Cysteine: This is a derivative of amino acid that is highly effective in treating the effects of acetaminophen overdoses, as well as mushroom poisoning.
  • Penicillin: When given in high doses, this common antibiotic can combat toxins such as mushrooms.


For all other cases of acute liver failure, a liver transplantation is the only treatment option. This involves removing the diseased liver and replacing it with a healthy donor liver.

Because of how quickly acute liver failure can progress, patients who are eligible for a liver transplantation will be given a “status one” classification on the transplant waiting list. This lets them bypass other patients and receive a donor liver much sooner, often within just 48 to 72 hours.

Learn more about liver transplantations here


Due to its rapid development, acute liver failure is often fatal if not treated as soon as possible. However, with timely medical attention, it’s often possible to make a full recovery.

After Medication

Patients who develop acute liver failure after overdosing on acetaminophen, ingesting toxins, or contracting hepatitis and who begin a medication regimen soon enough (within 48 hours of signs or symptoms of the disease) typically are able to reverse the condition and regain their health.

After Transplantation

Patients who undergo a liver transplantation also typically enjoy excellent outcomes. According to data compiled by the Organ Procurement and Transplantation Network (OPTN), the national survival rate for deceased donor liver transplants performed between 2008 and 2015 was:

  • 91 percent one year after surgery
  • 83 percent three years after surgery
  • 75 percent five years after surgery

Patients who undergo a liver transplantation will need to take a variety of medications, such as immunosuppressants, often for the rest of their lives to ensure their new liver continues to function normally.

Preventing Recurrence

Acute liver failure is a rare condition and is extremely unlikely to recur. 

However, chronic diseases like hepatitis can come back, which will increase the likelihood of developing acute liver failure again. Fortunately, several new antiviral medications have been developed recently that have led to significantly improved outcomes for viral hepatitis patients. Regardless, patients at risk of recurrence should still remain under close medical observation to reduce the chance of additional infection.

Next Steps 

If you think you or someone you know may have acute liver failure, seek medical attention immediately. Call us at (877) LIVER MD/ (877) 548-3763 or use our online form to schedule an appointment.