Fulminant liver failure, or acute liver failure, is a life threatening condition that happens when liver function rapidly deteriorates. It can affect people with no preexisting liver disease. The possible causes of fulminant liver failure include viral infections, toxic reactions, and autoimmune diseases.

The liver is a filter that cleanses the blood and removes toxins from the body. It also has other critical functions, such as producing protein and cholesterol, supporting digestion, and helping the body fight infection.

As a result, when something goes wrong with the liver, this can have serious consequences.

People with fulminant liver failure often present with abdominal swelling, jaundice, and changes in mental function. If enlargement causes the liver capsule to stretch, a person may also experience abdominal pain. The treatment typically involves liver transplantation.

In the United States, there are about 2,800 reported cases of acute liver failure a year.

Keep reading to learn more about fulminant liver failure, including the causes, symptoms, and treatment of the condition.

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Fulminant liver failure is rare and can happen in people with no previous history of liver disease. The condition commonly affects people with a weakened immune system.

Viral hepatitis and drug-induced hepatitis are the two most common causes. Drug-induced hepatitis accounts for almost 50% of cases in the United States, with acetaminophen being the most common culprit.

Other possible causes include:

  • hypoxia-induced liver injury, which may occur in people with heart failure
  • blood clots blocking the hepatic veins that drain the liver
  • blockages to the small blood vessels in and around the liver
  • Wilson’s disease, a genetic disorder that causes copper to accumulate
  • the ingestion of Amanita phalloides, a mushroom that commonly causes damage to the liver
  • sepsis, or blood poisoning
  • autoimmune hepatitis
  • liver diseases in pregnancy, such as acute fatty liver of pregnancy and HELLP syndrome
  • heatstroke
  • cancer
  • other viral diseases
  • the narrowing or blocking of hepatic veins, known as Budd-Chiari syndrome

Determining the cause of fulminant liver disease will allow doctors to determine the best treatment and the likely outcome.

Certain factors might increase a person’s risk of developing fulminant liver failure. These include:

  • living with alcohol use disorder
  • living with hepatitis
  • having a low nutritional status
  • being female
  • being older than 40 years

Other factors can contribute to acetaminophen-induced liver failure, including:

The symptoms may depend on the cause of the acute liver failure and how much time has passed since the onset of the disease. Possible symptoms include:

  • jaundice, which is the term for a yellowing of the skin and eyes
  • ascites, which is an accumulation of fluid in the abdomen
  • abdominal pain, if the liver capsule becomes stretched
  • nausea
  • vomiting
  • malaise, or feeling generally unwell
  • dehydration

People may also experience symptoms related to a condition called hepatic encephalopathy, which affects the brain. The symptoms might include mental clouding, confusion, and even falling into a coma.

Learn more about the symptoms of liver failure.

Doctors use the individual’s symptoms and medical history to diagnose fulminant liver failure, along with certain laboratory tests.

They may suspect fulminant liver failure if a person without underlying chronic liver disease or cirrhosis has a sudden onset of:

  • jaundice
  • elevated enzymes called transaminases
  • bleeding problems
  • mental status changes

Doctors use laboratory tests to confirm liver failure and its severity. These include:

  • blood tests to check for the liver enzymes AST and ALT
  • bilirubin level
  • prolongation of prothrombin time (PT)

In cases of fulminant liver failure, doctors may see elevated bilirubin and liver enzymes, as well as a high PT. When the PT is high, it takes longer for blood to clot. This is because the liver is not making enough blood clotting proteins.

Other potential findings are:

  • low platelet count
  • low blood sugar
  • elevated ammonia
  • features of kidney damage, such as elevated serum creatinine

Doctors should also test people with acute liver failure for complications. These tests may include:

  • complete blood count (CBC)
  • serum electrolytes, checking for calcium, phosphate, and magnesium
  • renal function tests
  • abdominal imaging, this is to rule out other liver diseases
  • blood culture

People with fulminant liver failure will receive care in an intensive care unit. The treatment may depend on the underlying cause, but it typically involves:

  • N-acetylcysteine (NAC), for acetaminophen poisoning
  • antivirals, for acute hepatitis B
  • steroids, for autoimmune flare-ups
  • penicillin, for mushroom poisoning

Doctors manage liver failure with aggressive supportive measures to avoid multiorgan failure until the individual recovers or has a liver transplant.

The liver plays many important roles in the body. Due to this, people with fulminant liver failure have an increased risk of various complications, including:

  • brain swelling that causes mood changes, disorientation, lethargy, confusion, or coma
  • bleeding in the upper gastrointestinal tract
  • hepatitis-associated aplastic anemia, a rare but life threatening condition
  • multiple, severe infections
  • kidney failure
  • nutritional and metabolic problems
  • lung problems, such as pulmonary edema, pneumonia, and tracheobronchitis

The outlook for people with fulminant liver failure is improving with advances in transplants. The current 1-year survival rate is greater than 65%.

A person’s outlook may depend on their age, the disease severity, and whether they have hepatic encephalopathy.

There is no definite way to prevent fulminant liver failure. However, maintaining optimal liver health may reduce the risk of developing this condition. People can improve their liver health by:

  • Getting vaccinated: People should have vaccinations against hepatitis A and hepatitis B.
  • Maintaining a moderate weight: Obesity can lead to fatty liver disease and non-alcohol-related fatty liver disease (NAFLD).
  • Eating a balanced diet: A person can boost their fiber intake by eating plenty of fresh fruits, vegetables, and whole grains. They should also drink lots of water.
  • Exercising regularly: Physical activity burns triglycerides and reduces liver fat.
  • Moderating alcohol intake: Alcohol can destroy liver cells and scar the liver.
  • Refraining from using nonmedical drugs: These substances damage the liver, as do unsterile needles and other drug equipment.
  • Avoiding sharing personal hygiene items: These include razors, toothbrushes, and nail clippers.
  • Practicing safe sex: Using barrier methods can help protect against hepatitis B and hepatitis C.
  • Following the directions on all prescriptions: Taking medications incorrectly can affect the liver.

Anyone with symptoms of liver problems should consult a doctor as soon as possible. The early diagnosis and treatment of liver disease can improve the chances of a better outcome.

People with chronic liver conditions should see a doctor regularly to check their health status and catch any problems at an early stage.

Fulminant liver failure is a severe deterioration of liver function that can happen suddenly. It can occur because of viral infections and drug toxicity.

The treatment involves aggressive supportive measures to avoid multiorgan failure. In many cases, a liver transplant might be necessary.

Taking steps to protect liver health may reduce the risk of developing fulminant liver failure. People should also see a doctor promptly for any liver problems to ensure the best possible outcome.