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Acute liver failure

Insufficientia hepatis acuta · Akutní selhání jater

What it is

Sudden loss of liver function in someone without prior liver disease — jaundice, clotting failure and confusion within weeks; paracetamol overdose is the leading cause in the UK and US, hepatitis viruses elsewhere.

Symptoms & signs

  • Jaundice
  • confusion, drowsiness
  • bleeding, bruising
  • nausea, vomiting
  • low blood sugar

🚩 Get help if…

  • call 112 / 911 now Confusion, drowsiness or odd behaviour with yellow skin
  • call 112 / 911 now Vomiting blood or black stools
  • call 112 / 911 now Any paracetamol overdose — even without symptoms
  • see a doctor soon Yellow skin or eyes with vomiting or bruising

Where it strikes

Medical treatment

  • INR, bilirubin, ammonia, paracetamol level
  • N-acetylcysteine — near-complete protection within 8 hours of paracetamol overdose trials support
  • N-acetylcysteine in other causes — helped early-stage patients in one trial mixed evidence
  • intensive care: glucose, brain swelling
  • early referral to a transplant centre (King's College criteria)
  • emergency liver transplant
  • antivirals for hepatitis B; stop culprit drugs

Natural & lifestyle

  • Keep paracetamol within the dose (4 g a day in adults)
  • no alcohol
  • avoid unregulated supplements — a known cause

Emerging & experimental

  • High-volume plasma exchange — better transplant-free survival in one trial trials support
  • liver dialysis
  • hepatocyte transplantation

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Intravenous silibinin — case series in death-cap mushroom poisoning early / small studies
  • Milk thistle — no benefit shown in liver disease trials mixed evidence

ICD codes