Acute liver failure is a rare but life-threatening critical illness that occurs most often in patients who do not have preexisting liver disease. With an incidence of fewer than 10 cases per million persons per year in the developed world, acute liver failure is seen most commonly in previously healthy adults in their 30s and presents unique challenges in clinical management. The clinical presentation usually includes hepatic dysfunction, abnormal liver biochemical values, and coagulopathy; encephalopathy may develop, with multiorgan failure and death occurring in up to half the cases.

The rarity of acute liver failure, along with its severity and heterogeneity, has resulted in a very limited evidence base to guide supportive care.4 However, rates of survival have improved substantially in recent years through advances in critical care management and the use of emergency liver transplantation. In this review, we outline the causes and clinical manifestations of acute liver failure and discuss current approaches to patient care.