Comprehensive Acute Liver Failure (ALF) Diagnosis & Treatment in India

Acute Liver Failure (ALF)

Acute liver failure occurs when your liver rapidly loses its ability to function. Acute liver failure (ALF) is a serious condition requiring intensive monitoring and urgent specialist care. If not managed properly, it’s almost always fatal. Our “Liver team” is geared to provide the required medical treatment, intensive care and if indicated surgical care (liver transplant) for these patients. Patients with acute liver failure are treated in liver intensive care unit (Liver ICU).

Common causes of Acute Liver Failure:

  • Hepatitis A, E, B
  • Acetaminophen overdose (Paracetamol poisoning)
  • Ratol poisoning
  • Drug induced liver failure
  • Wilson’s disease
  • Acute fatty liver of pregnancy


ALF is a medical emergency and requires prompt medical evaluation and treatment. 

Patients with ALF often require admission to liver intensive care unit and are probably best managed at the centre that performs liver transplantation, which can be life-saving for such patients.

Treatment includes:

  • For low blood pressure: IV Fluids. If required medications to maintain blood pressure.
  • For hepatic encephalopathy: Oral lactulose (a laxative) and lactulose enemas.
  • If intracranial pressure is raised: Mannitol and other neuroprotective strategies.
  • For infections: Antibiotics or antifungal drugs
  • For low blood sugar: Glucose given intravenously.
  • For bleeding: Transfusions of fresh frozen plasma (the fluid part of the blood which contains clotting factors) and, when necessary, Packed Cell Volumes (PCV).
  • For breathing difficulty: mechanical ventilation

What are the signs and symptoms of Acute Liver Failure (ALF)?

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
  • Diarrhea

However, as liver failure progresses, the symptoms become more serious, requiring urgent care. These symptoms include:

  • Jaundice
  • Weakness
  • Excessive sleepiness
  • Confusion
  • Coma

How to diagnose Acute Liver Failure (ALF)?

Investigations to diagnose Acute Liver Failure includes:

  • Blood tests. Blood tests are done to determine current status of liver as well as cause of liver failure. A prothrombin time test measures how long it takes your blood to clot. With acute liver failure, blood doesn’t clot as quickly as it should.
  • Imaging tests. Usually ultrasound of abdomen with liver doppler is performed to rule out chronic liver disease. Sometimes abdominal computerized tomography (CT) scan is recommended to evaluated liver and it’s blood vessels. These tests can look for certain causes of acute liver failure, such as Budd-Chiari syndrome or tumors. They may be used if there is any suspicion on ultrasound.
  • Arterial ammonia: When liver is not working properly as in case of acute liver failure, blood ammonia level rises. If blood ammonia level is very high, patient might need dialysis support.

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