Liver Failure — Acute

The liver’s job is to detoxify all the food we eat & drugs we take (& anything else that gets into our stomachs).ย  If it stops working, ammonia builds up from toxins, affecting the brain. This can happen suddenly for a variety of reasons, none of which are common.ย  Acute Liver Failure is different from the much more frequent causes of chronic liver failure, which occurs gradually as the liver gets scarred down over years from various diseases (see Cirrhosis).

When acute liver failure begins, the person simply feels bad.  They lose their appetite, get nauseous, may have discomfort in the right-upper abdomen (or may not).  As the failure progresses, they vomit, might itch all over, eventually turn yellow and become confused.  At that point, they’ll die without an emergency transplant.  The disease can evolve within a few days, depending on the cause.

The main causes of acute liver failure are:

  • Poisoning, especially from acetaminophen (Tylenolยฎ), usually in massive overdose, but sometimes from accidentally taking lots of different over-the-counter products that happen to contain it.ย  Other overdoses kill the liver too, as can many poisons, including death cap mushrooms.
  • Hepatitis A and B cause acute liver failure in about 1 in 500 people each.ย  Hepatitis A is usually mild, but is most dangerous for those with other liver diseases.ย  Vaccines are available.ย  See Hepatitis (Types).
  • Any medication can cause liver failure in rare people who are genetically susceptible.ย  It’s always rare, & no way to know.ย  Herbal medicines can too, especially when mixed.
  • Alcohol binges in people who already have bad livers, from previous alcohol or something else.
  • Many common viruses, in very rare cases.
  • Various rare diseases
  • Uncommon complication of pregnancy (the “HELLP syndrome”)
  • In certain poorer countries, Hepatitis E causes fatal acute liver failure in 20% of pregnant women (esp. Russia, Pakistan, India, Mexico).

We diagnose acute liver failure by finding elevated liver enzymes (ALT and AST) in a common blood test, showing us that something is happening there.ย  But to tell how bad it is, we have to order the Prothrombin Time separately (it requires drawing blood in a different test tube).ย  The result is measured as an “international normalized ratio” or INR; 1.0 is normal, anything over 1.6 is clearly abnormal (it’s the same test to monitor the anticoagulant [“blood thinner”] warfarin).

Once again, acute liver failure is rare.  The people most at risk are those with known chronic liver diseases.  They should get vaccinated against Hepatitis A and B, avoid alcohol, avoid too much acetaminophen (some is OK), avoid raw oysters (carry a toxic bacteria), and be very careful with medicines, especially if over-the-counter or herbs.  Never take anything to “help” or “fortify” the liver, because there’s no such thing (though lots of stuff certainly gets sold).

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