Blog
Acute Liver Failure
Covenant Metabolic Specialists Health Library
Covenant Metabolic Specialists
Physician Reviewed
Dec 3, 2025
What is Acute Liver Failure?
Acute liver failure (also called fulminant hepatic failure) occurs when the liver suddenly loses its ability to function, usually within 26 weeks or less.
Unlike chronic liver disease, which builds over time, ALF happens fast—often within days.
This condition disrupts critical metabolic functions like detoxification, blood clotting, and nutrient processing. It is life-threatening and requires urgent medical care.
Symptoms
Symptoms of ALF may escalate quickly. Early signs can seem vague but rapidly progress into severe complications:
Fatigue or malaise
Nausea and vomiting
Loss of appetite
Abdominal pain (especially upper right quadrant)
Yellowing of the skin and eyes (jaundice)
Confusion or disorientation
Sleepiness or slowed thinking (hepatic encephalopathy)
Easy bruising or bleeding
Swelling in the abdomen (ascites)
Coma (in advanced stages)
Causes
The most common causes of acute liver failure include:
Acetaminophen overdose: The leading cause in the U.S.
Viral hepatitis (A, B, and rarely E)
Prescription or herbal medications (e.g., isoniazid, valproate, kava)
Autoimmune hepatitis
Metabolic disorders (e.g., Wilson’s disease)
Mushroom poisoning (Amanita phalloides)
Ischemia (loss of blood flow to the liver)
Cancer or infiltration of the live
In many cases, a cause is not found—this is known as indeterminate ALF.
Risk Factors
You may be more likely to develop acute liver failure if you:
Take high doses of acetaminophen or combine it with alcohol
Have chronic hepatitis infection and suddenly worsen
Use herbal supplements or traditional medicines with liver-toxic ingredients
Have autoimmune conditions
Use recreational drugs that damage the liver
Have a rare inherited metabolic disorder
Are exposed to toxins like poisonous mushrooms or industrial chemicals
Diagnosis
Early diagnosis of ALF is critical to survival. Diagnosis typically involves:
Medical History: Recent medication use, toxin exposure, alcohol intake
Physical Exam: Assessing for jaundice, confusion, and bleeding
Blood Tests:
Liver enzymes (ALT, AST)
Bilirubin
INR (blood clotting time)
Ammonia levels
Imaging: Ultrasound or CT to assess liver size and rule out obstructions
Liver Biopsy: Sometimes needed if cause is unclear
Viral panels and autoimmune testing
Rapid mental decline plus abnormal liver bloodwork and clotting is a hallmark of ALF.
Treatments
Prevention
Avoid acetaminophen overdose: Never exceed 3,000 mg per day and avoid combining it with alcohol.
Be cautious with supplements: Many herbal remedies are not regulated and can damage the liver.
Vaccinate against hepatitis A and B
Avoid wild mushrooms unless sourced from an expert
Limit alcohol and monitor liver labs if taking long-term medication
Our Take
Acute liver failure is one of the few true metabolic emergencies we see—and the speed of decline can catch anyone off guard.
Most patients have no prior liver problems. In many cases, it’s a missed acetaminophen overdose or unexpected drug interaction.
That’s why we push liver awareness and responsible medication use so strongly.
At Covenant, we don’t just treat—it’s our mission to screen and educate before crises happen.
