Best Acute Liver Failure Treatment in Delhi, India

Acute liver failure is the rapid onset of liver function loss, typically occurring within days or weeks, and it typically affects individuals without prior liver conditions. It's most frequently triggered by factors such as hepatitis viruses or specific medications like acetaminophen. It's less common than the slower-developing chronic liver failure.

Acute liver failure, also referred to as fulminant hepatic failure, can lead to severe complications, including bleeding and unconsciousness due to increased pressure within the brain. It's considered a medical emergency necessitating hospitalisation.

The potential for reversal depends on the underlying cause, with some cases responding to treatment. However, in many instances, a liver transplant is the sole definitive solution.

While there are no obvious causes in certain cases of acute liver failure, usually the acute liver failure causes include.

• Hepatitis A
• Hepatitis B
• Hepatitis C
• Acetaminophen (Paracetamol) overdose
• Reactions to certain prescription and herbal medications
• Ingestion of poisonous wild mushrooms

The initial symptoms of liver failure can be due to many conditions. Because of this, liver failure may be initially difficult to diagnose. Early symptoms include:

• Nausea
• Loss of appetite
• Fatigue
• Diarrhoea

With the progression of liver failure, the symptoms may become more serious. These symptoms include: 

• Jaundice
• Bleeding easily
• Swollen abdomen
• Mental disorientation or confusion (known as hepatic encephalopathy)
• Sleepiness
• Coma

Acute liver failure frequently gives rise to various complications, which may include:

• Cerebral Edema (Excess Brain Fluid): Acute liver failure can lead to an accumulation of excess fluid in the brain, a condition known as cerebral edema. This fluid buildup results in heightened pressure within the brain, leading to symptoms such as mental disorientation and confusion, and seizures.
• Bleeding and Clotting Disorders: A failing liver loses its ability to produce adequate clotting factors essential for blood coagulation. As a result, individuals with acute liver failure are prone to bleeding, especially in the gastrointestinal tract, and this bleeding can be challenging to manage.
• Infections: People suffering from acute liver failure have an elevated risk of developing infections, particularly in the bloodstream and in the respiratory and urinary systems.
• Kidney Failure: Kidney failure is a common subsequent complication following liver failure, particularly in cases of acetaminophen overdose. Acetaminophen toxicity can harm both the liver and the kidneys, leading to kidney dysfunction.

Diagnosing acute liver failure (ALF) is a critical medical process because it is a life-threatening condition characterised by rapid and severe liver dysfunction. The diagnosis involves several steps:

Medical History and Physical Examination

The first step is taking a detailed medical history, including information about recent illnesses, medication use, alcohol or drug consumption, and exposure to hepatotoxic substances. A physical examination is performed to look for signs of liver disease, such as jaundice (yellowing of the skin and eyes) and an enlarged liver.

Blood Tests

Blood tests are essential for assessing liver function and determining the underlying cause of ALF. These tests may include:

• Liver function tests: To assess the levels of liver enzymes (AST, ALT, ALP), bilirubin, albumin, and prothrombin time (INR).
• Viral serology: To check for viral hepatitis markers (HBV, HCV, etc.).
• Autoimmune markers: To assess for autoimmune hepatitis.
• Toxicology screens: To detect drug or toxin-induced liver injury.
• Blood clotting tests: To evaluate the liver's ability to synthesise clotting factors.
• Blood ammonia levels: To assess for hepatic encephalopathy.

Imaging

In some cases, imaging studies like ultrasound, CT scans, or MRI may be performed to evaluate the liver's size, shape, and any anatomical abnormalities. These tests can help identify structural issues or complications such as fluid buildup in the abdomen (ascites).

Liver Biopsy

Liver biopsy is usually not needed for diagnosis of acute liver failure. However, it may be needed when the cause of ALF is unclear or when autoimmune or metabolic conditions are suspected.

If detected early enough, acute liver failure caused by an overdose of acetaminophen can sometimes be treated and its effects reversed. Likewise, if a virus causes liver failure, supportive care can be given at a hospital to treat the symptoms until the virus runs its course. In these cases, the liver will sometimes recover.

For liver failure that is the result of long-term deterioration, the initial treatment goal may be to save whatever part of the liver is still functioning. If this is not possible, then a liver transplant is required. Fortunately, liver transplant is a common procedure that is often successful. Max Hospital is one of the best hospitals for liver transplant in India.

Medications to Reverse Poisoning

In cases of acute liver failure resulting from poisoning, such as acetaminophen overdose or exposure to toxic substances like mushrooms, the primary approach involves the administration of medications aimed at reversing the poisoning effects. A notable example is the use of acetylcysteine for acetaminophen overdose, which helps neutralise the toxic effects and support liver recovery. Additionally, specific drugs are employed to counteract the toxins responsible for liver damage. In short, medications are one of the most effective hepatic failure treatments that help in mitigating the harm inflicted on the liver and improving the patient's chances of survival.

Liver Transplantation

When acute liver failure reaches a critical stage where it cannot be reversed by other treatment modalities, a liver transplant becomes the sole viable acute liver failure treatment option. This complex surgical procedure involves the removal of the patient's severely damaged liver and its replacement with a healthy liver from a deceased or living donor. Liver transplantation offers renewed hope for patients facing life-threatening liver failure, providing them with a chance at a fresh start and the potential for a full recovery. It is a critical intervention that can be lifesaving when other acute liver failure treatments have proven ineffective.

1. Can acute liver failure be reversed?

Acute liver failure can sometimes be reversible, especially if the underlying cause is identified and treated promptly. However, the chance of reversal depends on the extent of liver damage and how quickly medical intervention occurs.

2. What is the best indicator of acute liver failure?

The best indicator of acute liver failure is typically elevated liver enzymes in blood tests, elevated prothrombin time along with symptoms such as jaundice (yellowing of the skin and eyes), confusion, and bleeding disorders.

3. Can the liver repair itself after acute liver failure?

The liver has the remarkable ability to regenerate, and in some cases, it can repair itself after acute liver failure. However, this depends on the extent of damage and the underlying cause. Severe damage may require medical intervention or a liver transplant.

4. What is emergency treatment for liver failure?

Emergency treatment for liver failure often includes hospitalisation, supportive care, and addressing the underlying cause. In some cases, a liver transplant may be necessary to save the patient's life.

5. How long can one survive acute liver failure?

The survival rate for acute liver failure can vary widely depending on factors such as the cause of the condition, the patient's overall health, and the timing of medical intervention. Without prompt treatment, it can be life-threatening.

6. How can I prevent acute liver failure?

Acute Liver Failure can often be prevented by practising safe medication use (especially with pain relievers like acetaminophen), and getting vaccinated against hepatitis. Regular medical check-ups can also help identify potential liver issues early.

Reviewed By Dr. Sanjiv Saigal - Principal Director & Head, Liver Transplant and Biliary Sciences, Gastroenterology, Hepatology & Endoscopy on 6 Nov 2024.

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