Acute Liver Failure (ALF)

Definition

  • Acute insult to liver + coagulopathy + encephalopathy; most w/o known preexisting liver dis.
  • Hyperacute if encephalopathy <7 d from jaundice onset; acute if 7–21 d, subacute if >21 d
  • Acute on chronic liver failure: acute insult to liver in Pt w/ underlying chronic liver disease

Etiology (J Hepatol 2015;62:S112)

  • Drugs/toxins (nearly 80% of cases in U.S.; Gastro 2015;148:1353, Clin Liver Dis 2017;21:151)
    • Drugs: acetaminophen (most common cause; >40% of all cases in U.S., typically unintentional overdose); anti-TB drugs (INH, rifampin, pyrazinamide); AEDs (phenytoin, valproate, carbamazepine); NSAIDs dose related); abx (eg, fluoroquinolones, macrolides); MDMA (ecstasy)