Acute Liver Failure (ALF) occurs when a lot
of the cells in the liver die in a short period of time (usually
within few days to weeks), so that most of the liver's function
It usually develops rapidly and demands immediate care.
ALF should not be confused with other types
of liver failure due to Cirrhosis or Chronic Hepatitis, which
normally take years to develop.
The common causes are Hepatitis B, Hepatitis
A, Hepatitis E, pregnancy, toxic doses of paracetamol (Crocin,
Tylenol) and other drugs, and Wilson's disease (defect of copper
metabolism). In a third of cases, the cause remains unknown
Acute Liver Failure Symptoms
These include all the symptoms of Hepatitis,
including fatigue, nausea, vomiting, and jaundice (yellow discoloration
of the skin and whites of the eyes) which may deteriorate rapidly.
At a certain point, most patients become confused
or sleepy and may go into coma.
They can also bleed from the gums or stomach,
and they can bruise easily due to poor blood clotting.
Early on, ALF is difficult to diagnose because
it resembles other illnesses and is quite rare.
Treatment of Acute Liver Failure
Since ALF progresses so quickly, time is of
the essence. It is important that patients with ALF be seen
at by doctors experienced in treating ALF and in liver transplantation.
Majority of patients can be successfully treated
in a dedicated Liver Unit with ICU support and medicines by
specialised liver physicians (Hepatologists).
However, a third of the patients may continue
to deteriorate despite the best medical treatment and may need
consideration for an urgent liver transplant. The indicators
that this may be necessary are: high level of jaundice (more
than 12mg/dl), worsening clotting defect indicated by prothrombin
time (PT) higher than 50 seconds, worsening mental status or
coma, when the interval between beginning of jaundice and mental
confusion/sleepiness is longer than 7 days, when the patient's
age is less than 10 or more than 40 years, when the cause of
the ALF is not known, and worsening kidney function. Patients
who have 3 or more of these indicators have less than 10% chance
of surviving without a transplant and about 60% chance with