Description

Acute hepatic failure is the sudden reduction in the function of the liver following an acute illness or injury. It is associated with jaundice, coagulopathy and encephalopathy in the absence of pre-existing liver disease. Aside from removal of the causative agent e.g. cessation of drugs (direct toxic effects or idiosyncratic adverse reaction) and the use of N-acetylcysteine in paracetamol overdose, there are no specific curative treatment options other than orthotopic liver transplantation. Current research focuses on developing extra-corporeal liver support systems but level-1 evidence of their clinical efficacy is still lacking. Intensive care management is built on the foundation of high standards of organ support for respiratory, cardiovascular, renal, neurological and haematological systems allowing for the possibility of hepatic regeneration or as a bridge to buying the time necessary to find a suitable organ donor for transplantation. Mortality without liver transplant (usually from intracranial hypertension or severe sepsis with multi-organ failure) remains as high as 90%. With successful transplant oneyear mortality can be significantly reduced.