Acute liver failure (ALF) is a life-threatening emergency where the liver loses function rapidly in a person without prior liver disease. Immediate specialist intervention can be life-saving.
Acute liver failure (ALF) is defined as severe acute liver injury with encephalopathy and coagulopathy (INR ≥ 1.5) in a patient without pre-existing liver disease, presenting within 26 weeks of illness onset.
Without treatment, ALF has >80% mortality. With intensive medical management and urgent transplant when indicated, survival rates exceed 60%.
If any of these signs are present in someone with jaundice, do not wait. Seek emergency care and contact Dr. Srinivas immediately.
ICU admission with monitoring of neurological status (encephalopathy grade), coagulation (INR, PT), renal function, and haemodynamics. Central venous and arterial line placement.
Comprehensive viral hepatitis serology, drug history, autoimmune screen, ceruloplasmin (Wilson's), Budd-Chiari imaging. Treatment of specific causes where available (N-acetylcysteine for paracetamol, steroids for AIH).
Cerebral oedema (mannitol, ICP monitoring), renal failure (CRRT), coagulopathy, hypoglycaemia correction, sepsis surveillance and treatment, nutrition support.
Continuous reassessment using King's College Criteria or MELD to determine transplant necessity. Simultaneous listing with ZCCK/TRANSTAN for deceased donor. LDLT from family member can bypass organ waiting time in urgent cases.
