Acute Liver Failure (ALF): Acute liver failure occurs when your liver rapidly loses its ability to function. Acute liver failure (ALF) is a serious condition requiring intensive monitoring and urgent specialist care. If not managed properly, it’s almost always fatal. Our “Liver team” is geared to provide the required medical treatment, intensive care, and if indicated surgical care (liver transplant) for these patients. Patients with acute liver failure are treated in the liver intensive care unit (Liver ICU).
Common causes of Acute Liver Failure:
- Hepatitis A, E, B
- Acetaminophen overdose (Paracetamol poisoning)
- Ratol poisoning
- Drug-induced liver failure
- Wilson’s disease
- Acute fatty liver of pregnancy
Treatments
ALF is a medical emergency and requires prompt medical evaluation and treatment. Patients with ALF often require admission to a liver intensive care unit and are probably best managed at the center that performs liver transplantation, which can be life-saving for such patients.
Treatment includes:
- For low blood pressure: IV Fluids. If required medications to maintain blood pressure.
- For hepatic encephalopathy: Oral lactulose (a laxative) and lactulose enemas.
- If intracranial pressure is raised: Mannitol and other neuroprotective strategies.
- For infections: Antibiotics or antifungal drugs
- For low blood sugar: Glucose is given intravenously.
- For bleeding: Transfusions of fresh frozen plasma (the fluid part of the blood that contains clotting factors) and, when necessary, Packed Cell Volumes (PCV).
- For breathing difficulty: mechanical ventilation
What are the signs and symptoms of Acute Liver Failure (ALF)?
The initial symptoms of liver failure can be due to many conditions. Because of this, liver failure may be initially difficult to diagnose. Early symptoms include:
- Nausea
- Loss of appetite
- Fatigue
- Diarrhea
However, as liver failure progresses, the symptoms become more serious, requiring urgent care. These symptoms include:
- Jaundice
- Weakness
- Excessive sleepiness
- Confusion
- Coma
How to diagnose Acute Liver Failure (ALF)?
Investigations to diagnose Acute Liver Failure include:
Blood tests: Blood tests are done to determine the current status of the liver as well as the cause of liver failure. A prothrombin time test measures how long it takes your blood to clot. With acute liver failure, blood doesn’t clot as quickly as it should.
Imaging tests: Usually, an ultrasound of the abdomen with a liver Doppler is performed to rule out chronic liver disease. Sometimes abdominal computerized tomography (CT) scan is recommended to evaluate the liver and its blood vessels. These tests can look for certain causes of acute liver failure, such as Budd-Chiari syndrome or tumors. They may be used if there is any suspicion of ultrasound.
Arterial ammonia: When the liver is not working properly as in the case of acute liver failure, the blood ammonia level rises. If the blood ammonia level is very high, the patient might need dialysis support.
