Neurospine Hospital & Revive Critical Care
ACUTE LIVER FAILURE
Acute liver failure (ALF) occurs when many cells in the liver die or become very damaged in a short amount of time. This causes the liver to fail to work as it should.
The liver removes toxins from the body, helps maintain blood glucose levels, is a part of the immune system and regulates blood clotting. When the liver fails it is an emergency and needs to be treated immediately.
It’s most commonly caused by a hepatitis virus or drugs, such as acetaminophen. Acute liver failure is less common than chronic liver failure, which develops more slowly.
Causes of Acute Liver Failure
Acute liver failure has many causes. Acetaminophen is one common medicine that can affect how the liver works. This can happen if a child is given the wrong dose of medicine or if too much is taken in a short amount of time.
Other causes of acute liver failure are:
- Metabolic conditions (problems with the physical and chemical processes inside the liver that must happen for a person to live)
- Infections / viruses
- Immunological dysfunction
- Cardiovascular conditions (which cause a lack of blood supply to the liver)
Causes of Acute Liver Failure
- Infections: Herpes simplex, echovirus, adenovirus, hepatitis B, parvovirus, others
- Drugs / toxins: Acetaminophen
- Cardiovascular: Extracorporeal membrane oxygenation, hypoplastic left heart syndrome, shock, asphyxia, myocarditis
- Metabolic: Galactosemia, tyrosinemia, iron storage, mitochondrial condition, HFI, fatty acid oxidation, others
- Immune: Autoimmune hepatitis, immune dysregulation, immune deficiency, hemophagocytic lymph histiocytosis
Diagnosis of Acute Liver Failure
Lab studies and a physical exam can tell if there are signs of a liver problem. These include:
- Signs of mental confusion (encephalopathy)
- Levels of liver enzymes that increase very quickly
- Jaundice
- Coagulopathy (problem with blood clotting)
Treatment for Acute Liver Failure
Treatment for acute liver failure depends on what caused the disease. Some causes can be treated by medicine or a liver transplant.
Supportive care – There are some patients who will get better on their own if they receive treatment for their symptoms. Many patients whose condition is caused by a virus get better on their own. Their liver is able to reform itself into a healthy organ.
Medicine – When the acute liver failure is caused by a cardiovascular condition, the immune system, or by acetaminophen, it can sometimes be treated with medicine. Medicine may be able to reverse it if given early enough. Metabolic diseases may be treated with medicine or diet if there has not yet been any damage that cannot be reversed.
Transplant – Children with acute liver failure need a liver transplant to survive. For most patients whose cause of liver failure is not known, a transplant is the only option.
- If the cause of the disease if known
- The likelihood the transplant will be a success
- Whether there is a disease in more than one organ or part of the body
- The amount of brain damage
- The chances that the brain damage could be reversed after the transplant liver is working.
Treating encephalopathy – Hepatic encephalopathy always develops when liver failure is sudden and severe. It is treated by trying to prevent the production of toxic products in the liver, which cause the condition.
Treating coagulopathy − Medicines or blood products may be needed if blood clotting problems become unsafe.