Acute Liver Failure (Fulminant Hepatic Failure)

Acute liver failure or fulminant hepatic failure takes place when the liver begins to fail very rapidly because of severe damage to liver cells. All of most of the important functions of the liver are lost. Acute liver failure is rare in children, but is very serious because it develops so fast.

Causes of Acute Liver Failure

While the cause of acute liver failure in children is commonly unknown, some causes may include:

  • Metabolic conditions
  • Infection
  • Viruses (such as Hepatitis A or B)
  • Exposure to toxins or poisons
  • Overdose of certain medications that affect the liver (ex. Acetaminophen, otherwise known as Tylenol)

The causes of acute liver failure vary by age. The most common causes for infants and children under age 2 are infections or metabolic conditions, while overdoses and exposures to viruses and toxins are more common in older children. Sometimes no cause can be found.


Symptoms of acute liver failure may include:

  • Nausea and vomiting
  • Fatigue
  • Loss of appetite
  • Feelings of anger, confusion or forgetfulness
  • Jaundice
  • Ascites
  • Edema (swelling of the feet and legs)

Eventually most children become confused or sleepy. They can also bleed from the gums or stomach or bruise easily due to poor blood clotting.


Because early symptoms mirror other illnesses, acute liver failure is difficult to diagnose. Your child’s doctor may perform the following tests on your child to confirm acute liver failure:

  • Blood tests
  • Urine tests
  • Liver biopsy
  • CT scan
  • Ultrasound


Because acute liver failure progresses so quickly, children will need immediate specialized, emergency care. It is important that children with acute liver failure be treated at a center with experience in treating acute liver failure and in pediatric liver transplantation.

Treatment will vary depending on the cause of your child’s acute liver failure. Some of the following treatments may be given on their own or in combination with other treatments:

  • Medicine – different medicines may be given to treat the side effects of acute liver failure, especially if your child’s liver failure is caused by acetaminophen overdose, metabolic disease or a cardiovascular condition. If given early enough, some medicines can reverse your child’s condition.
  • Diet – your child may be asked to reduce the amount of protein and sodium he eats. Your child’s nutritionist will also make sure he is getting enough calories from his diet to keep up his strength.
  • Liver Transplant – because damage to the liver is often so severe with acute liver failure, a liver transplant may be the only option for some children. Approximately 50 percent of all children with acute liver failure need a liver transplant in order to survive.

Did You Know?

Children’s Liver Transplant team has some of the country’s highest survival rates for children transplanted with acute liver failure.