What you need to know about: acute liver failure

Br J Hosp Med (Lond). 2022 Sep 2;83(9):1-11. doi: 10.12968/hmed.2022.0051. Epub 2022 Sep 28.


Acute liver failure is a rare but important clinical syndrome, with a high mortality rate. Prompt recognition, appropriate management and early referral to a liver transplant centre can lead to good outcomes in these critically unwell patients. This article gives an overview of the key clinical challenges and optimal management of patients with acute liver failure. Acute liver failure is defined and a comprehensive list of aetiologies and suggested investigations is provided. The clinical challenges of sepsis, renal impairment, coagulopathy, hypoglycaemia, haemodynamic instability and cerebral oedema are discussed. Quadruple H therapy, a combination of therapies aimed to reduce cerebral oedema in acute liver failure, is described. A systemic guide to managing patients with acute liver failure is provided, as are indications for referral to a liver transplant centre.

Keywords: Acute liver failure; Fulminant liver failure; Intracranial hypertension; Liver transplantation; Quadruple H therapy.

MeSH terms

  • Brain Edema* / etiology
  • Brain Edema* / therapy
  • Humans
  • Hypoglycemia* / complications
  • Liver Failure, Acute* / complications
  • Liver Failure, Acute* / diagnosis
  • Liver Transplantation* / adverse effects