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Acute Liver Failure in Adults

Timothy C Marsh, DO and Jonathan T Cunningham, MD Reviewed 04/2024
 


BASICS

  • Acute Liver Failure (ALF) is a rare and life-threatening illness defined by jaundice, coagulopathy, and encephalopathy in an individual without preexisting liver disease.

  • ALF encompasses a broad...

DIAGNOSIS

ALF is a clinical diagnosis that includes: 
  • Acute altered mental status, i.e., hepatic encephalopathy

  • Profound coagulopathy (usually an international normalized ratio [INR] above 1.5-2)

  • Signs o...

TREATMENT

The timing of onset (hyperacute, acute, subacute) and etiology of ALF guide management. 

GENERAL MEASURES

  • Critical care and supportive measures are the cornerstone of therapy. All patients wit...

ONGOING CARE

Prognostic models evaluate the risk of mortality or the need for liver transplantation. Acetaminophen-associated ALF is best predicted using the King's College Criteria: 
  • Age

  • Cause of ALF

  • Pr...

REFERENCES

1
Shingina A, Mukhtar N, Wakim-Fleming J, etal. Acute Liver Failure Guidelines. Am J Gastroenterol. 2023;118(7):1128-1153.doi: 10.14309/ajg.0000000000002340.
2
Dharel N, Bajaj JS. Definition a...

ADDITIONAL READING

SEE ALSO

https://www.mdcalc.com/kings-college-criteria-acetaminophen-toxicity  

CLINICAL PEARLS

  • Acute liver failure is a rare, but life-threatening event.

  • The most common causes in developing nations relate to viral infections; drug-induced liver injury is most common in developed...

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