Acute Liver Failure – Symptoms and Causes

Overview

Acute liver failure happens when the liver suddenly stops working properly, often within a few days or weeks. This condition typically affects people with no previous liver problems.

The most common causes are hepatitis viruses and certain medications, particularly acetaminophen (also known as paracetamol). Unlike chronic liver failure, which develops gradually, acute liver failure comes on rapidly.

Medical professionals sometimes call it fulminant hepatic failure. This condition is serious and can lead to dangerous complications, including:

• Uncontrolled bleeding
• Brain swelling
• Other life-threatening issues

Patients with acute liver failure need immediate hospitalization and intensive care. Some cases can be reversed with proper treatment, depending on what caused the problem. However, many patients ultimately need a liver transplant as the only effective solution.

Signs and Symptoms

Acute liver failure shows several warning signs. The most common symptom is jaundice, which makes the skin and eyes look yellow.

People often feel pain in the upper right stomach area. Some individuals may experience abdominal swelling due to fluid accumulation.

Feeling sick to the stomach with nausea and vomiting is common. Many people report experiencing a pervasive sense of malaise. Mental changes can happen too—confusion, disorientation, or unusual sleepiness may develop.

Other symptoms include:

• Breath with an unusually sweet or musty smell
• Trembling or shaking
• Swelling in the abdomen

When Medical Help Is Needed

Don’t wait to get help if these symptoms appear. Acute liver failure can happen quickly, even in healthy people, and it can be deadly.

Seek emergency medical care right away if you notice:

• Yellowing of the skin or eyes
• Pain or tenderness in the upper belly
• Confusion or personality changes
• Extreme sleepiness
• Unusual behavior

Causes

Acute liver failure happens when liver cells become seriously damaged and stop working properly. There are many different factors that can lead to this condition.

Acetaminophen overdose is the primary cause of acute liver failure in the U.S. This can occur after taking one extremely large dose or after taking higher-than-recommended amounts daily for several days.

Viral infections greatly elevate the risk. These include hepatitis A, B, and E, as well as Epstein-Barr virus, cytomegalovirus, and herpes simplex viruses.

Several medications can damage the liver enough to cause failure. These include:

• Certain antibiotics
• Nonsteroidal anti-inflammatory drugs
• Anticonvulsants

Herbal supplements have been linked to acute liver failure as well, including:

• Kava
• Ephedra
• Skullcap
• Pennyroyal

Exposure to toxins poses a significant threat. The poisonous wild mushroom Amanita phalloides is sometimes mistakenly eaten, causing severe liver damage. Industrial chemicals like carbon tetrachloride, found in refrigerants and solvents, can also be toxic to the liver.

Autoimmune hepatitis—where the body’s immune system attacks liver cells—can lead to liver failure. Vascular diseases that affect the liver’s blood vessels, like Budd-Chiari syndrome, can lead to blockages and cause acute liver failure.

Rare metabolic conditions like Wilson’s disease and acute fatty liver of pregnancy can sometimes trigger liver failure. Cancer originating in or spreading to the liver may also cause the organ to fail.

Reduced blood flow to the liver during sepsis (overwhelming infection) or shock can severely damage the organ. Even heat stroke from extreme physical activity in hot environments can trigger acute liver failure.

In some cases, medical professionals cannot identify a clear cause of acute liver failure despite thorough investigation.

Risk Factors

People who might develop acute liver failure include:

• Women – Most cases occur in females.
• People with certain health conditions—viral hepatitis, metabolic disorders, autoimmune diseases, and cancer—can increase their risk.

These factors don’t guarantee liver failure will occur, but they may increase someone’s chances of developing this serious condition.

Complications

Acute liver failure can lead to several serious health issues. One key problem is brain swelling, where excess fluid builds up in the brain tissue. This swelling creates pressure that may cause confusion, disorientation, and even seizures in patients.

Bleeding problems are also common. The failing liver can’t produce enough clotting factors, which makes it harder for blood to clot normally. This often results in gastrointestinal bleeding that doctors may struggle to control.

Infections pose another significant risk. Acute liver failure weakens the immune system, increasing the risk of infections in the bloodstream, lungs, and urinary tract.

Kidney failure frequently develops alongside liver failure. This is especially true in cases of acetaminophen overdose, which can damage both organs simultaneously.

Ways to Prevent Liver Problems

Taking steps to protect your liver can reduce your risk of serious liver issues. Here are important prevention strategies:

Safe Medication Use

• Always follow dosage instructions on medicine labels
• Check with healthcare providers before taking acetaminophen if you have liver concerns
• Inform your doctor about all medications you take, including over-the-counter and herbal supplements

Lifestyle Choices Matter

• Limit alcohol consumption (women: up to one drink daily; men: up to two drinks daily)
• Maintain a healthy weight to prevent fatty liver disease
• Avoid illegal drug use, especially those requiring needles

Protection Against Infections

• Get vaccinated for hepatitis A and B, especially if you have existing liver disease
• Practice safe sex using condoms
• Choose reputable, clean shops for tattoos and piercings
• Don’t share personal items like razors or toothbrushes
• Take precautions when handling other people’s blood or body fluids

Environmental Safety

• Use aerosol sprays and cleaning chemicals in well-ventilated areas
• Wear protective clothing (gloves, long sleeves, and masks) when handling toxic substances
• Follow product safety instructions carefully
• Never eat wild mushrooms unless you are absolutely certain they are safe

Weight Management

• Excess weight can lead to metabolic dysfunction-associated fatty liver disease (MASLD)
• This condition, previously called nonalcoholic fatty liver disease, can cause significant liver damage
• Regular exercise and a balanced diet help maintain liver health

Avoid Smoking and Tobacco Products

• Smoking increases the risk of liver disease and many other health problems
• Quitting smoking improves overall health, including liver function

Living with Acute Liver Failure

Acute liver failure is a serious condition that requires ongoing care and support. People facing this challenge often need to connect with resources and others who understand their experience.

Transplant Support Groups

Connecting with others who have gone through similar experiences can provide valuable emotional support and practical advice. Support groups specifically for transplant patients offer a space to share concerns, ask questions, and learn from others’ experiences.

These groups let you:

• Ask questions about daily life after liver problems
• Share your experiences with others
• Learn practical tips for recovery
• Find emotional support during difficult times

Many patients find that talking to others who truly understand their situation helps reduce feelings of isolation. Healthcare providers often recommend these support communities as an important part of the healing process.

Both online forums and in-person groups provide invaluable opportunities for networking and connection. Your healthcare team can suggest local support options that might work for your situation.

Support groups offer valuable emotional support, but should not replace medical advice from your healthcare team.