Liver Failure

Liver Failure

Liver failure is life-threatening and demands urgent medical care. The problem with liver diseases is that often they do not show any symptoms until advanced stages. Liver failure is the final stage of many liver diseases but happens gradually.

The burden of liver disease in India is very high as it alone contributes to approx. 18% of the 20-lakh global liver disease–related deaths.

Acute liver failure, a rarer condition that happens rapidly (in as little as 48 hours or in days or weeks) and results in loss of liver function.

What are the signs and symptoms of Acute liver failure?

  • Yellowing of skin and eyeballs (jaundice)
  • Nausea
  • Vomiting
  • Pain in your upper right abdomen (Location of liver)
  • A swollen belly
  • A general sense of feeling unwell (malaise)
  • Confusion
  • Sleepiness
  • Breath has a musty or sweet odour
  • Tremors

What are the causes of Acute liver failure?

Most people with acute liver failure don’t have any type of liver disease or problem before this event. The causes include:

  • Paracetamol overdose: Large doses may damage liver or lead to failure (High doses are required)
  • Viruses: These are hepatitis A, B, and E, the Epstein-Barr virus, cytomegalovirus, and herpes simplex virus may lead to liver damage or cirrhosis.
  • Reactions to certain prescription and herbal medications
  • Eating poisonous wild mushrooms due to toxin in them which causes liver damage and failure.
  • Autoimmune hepatitis: Body’s own immune system attacks your liver, can lead to acute liver failure.
  • Wilson’s disease: Genetic disease prevents your body from removing copper. It builds up in and damages the liver.
  • Acute fatty liver pregnancy: A rare condition that results in excess fat build up on the liver and damages it.
  • Septic shock: An overwhelming infection in the body
  • Budd Chiari syndrome: A rare disease narrows and blocks the blood vessels in liver.
  • Industrial toxins: Many chemicals, including carbon tetrachloride, a cleaner and degreaser, can damage the liver.

What are the diagnostic tests for Acute liver failure?

Blood Tests:

To check how well the liver is working. The doctor also suggests a prothrombin time test, to check for time it takes to clot because with acute liver failure, blood doesn’t clot as quickly as it should.

Imaging tests: Detailed check for the workings of liver

  • Special ultrasound and MRI scans, and Abdominal computerized tomography (CT) scanning

Liver Biopsy:

  • A liver biopsy involves getting a tissue sample of your liver with a needle.
  • The needle removes a tiny piece of liver tissue that is seen under a microscope.

What are the treatment options in Acute liver failure?

People with acute liver failure often need immediate treatment in an intensive care unit of a hospital in a facility. It is preferable to be admitted in a hospital that can perform a liver transplant, if necessary. The designated doctor is the best person to take that decision.

Acute liver failure treatments may include:

Medications to reverse poisoning:

If caused by paracetamol overdose, medications are given to treat it and they also help treat other causes of acute liver failure.

Mushroom and other poisonings also may be treated with drugs that reverses its effects.

Liver transplant: If the acute liver failure cannot be reversed, doctors often advice liver transplant. During a liver transplant, a surgeon removes the damaged liver and replaces it with a healthy liver from a donor.

The doctor might also do the following to control symptoms and prevent complications caused by acute liver failure.

  • – Relieving pressure caused by excess fluid in the brain (Cerebral edema can increase pressure on the brain). Medications can help reduce the fluid buildup.
  • – Screen for infections: To initiate treatment for infection beforehand
  • – Preventing severe bleeding
  • – Providing nutritional support.

What can be done to prevent Acute Liver failure?

Reduce risk of acute liver failure by taking care of the liver.

  • Follow instructions on medications, don’t self medicate. Don’t take more than what the doctor prescribes.
  • Drink alcohol in moderation, if at all.
  • Avoid risky behavior of using illicit intravenous drugs, sharing needles, smoking.
  • Get vaccinated, in case of history of hepatitis infection or if a person has chronic liver disease. Talk to the doctor.
  • Avoid contact with other people’s blood and body fluids.
  • Don’t eat wild mushrooms, as it is difficult to tell the difference between a poisonous mushroom and one that is safe to eat.
  • Take care with aerosol sprays; wear a mask while using aerosol cleaners, spraying insecticides, fungicides, paint and other toxic chemicals.
  • Maintain a healthy weight; obesity may cause a condition called nonalcoholic fatty liver disease, which may include fatty liver, hepatitis, and cirrhosis.


  1. Mondal D, Das K, Chowdhury A. Epidemiology of Liver Diseases in India. Clin Liver Dis (Hoboken). 2022 Jan 28;19(3):114-117.
  2. What Is Liver Failure? WebMD. March 2024.
  3. Acute liver failure. Mayo Clinic. March 2024.

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