<unk>  is a sudden and severe loss of<unk>  function with evidence of encephalopathy and coagulopathy with elevated prothrombin time (PT) and (INR) in a person without a preexisting<unk>  disease. The effects of<unk>  are due to the loss of its metabolic, secretory and regulatory effects. This results in the accumulation of toxic substances which causes deleterious effects. The major pathophysiological mechanisms of morbidity and mortality in patients with<unk>  are cerebral edema, hypoperfusion to the<unk> , idiosyncratic drug reactions, depletion of glutathione and viral hepatitis.<unk>  may be classified on the basis of the time interval between the onset of symptoms and the development of encephalopathy as hyperacute, acute, subacute, fulminant, subfulminant and late-onset. Acetaminophen toxicity is the most common cause of<unk>  in the developed world and viral hepatitis (most commonly hepatitis A, hepatitis B and hepatitis E) is most common in the developing world.<unk>  must be differentiated from other diseases that cause signs and symptoms of jaundice, coagulopathy, and encephalopathy.  The further evaluation should include<unk>  function tests (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase, gamma-glutamyl transpeptidase [GGT], total and direct bilirubin, albumin) and prothrombin time/INR. The diagnosis of<unk>  is made in the presence of coagulopathy (international normalized ratio [INR], >1.5), hepatic encephalopathy and illness duration of fewer than 24 weeks. The commonly used prognostic indicators to predict mortality in patients with<unk>  and to identify patients who are likely to benefit from<unk>  transplantation include kings college criteria (use for<unk>  transplantation) and model for end-stage<unk>  disease (MELD) score (to predict mortality in patients with chronic and acute<unk>  disease). Common symptoms of<unk>  include anorexia, malaise, pruritis, bleeding tendencies, confusion, disorientation, and stupor. In the initial stages of<unk> , the patient may have mild mental status changes such as altered sleep pattern but may become confused or develop coma in the later stages as the disease progresses. Physical examination of<unk>  is remarkable for hepatomegaly, right upper quadrant abdominal tenderness, ascites and [[encephalopathy.  The management of<unk>  involves resuscitation of the patient with adequate nutrition and optimization of fluid balance, monitoring and treating the complications and providing nutritional support. The patient should be treated in an appropriate setting preferably a center with<unk>  transplantation facility. Infections and sepsis are common occurrences of fulminant<unk>  failure. The high standards of infection control should be practiced to minimize the nosocomial sepsis. In stage 3 and 4 encephalopathy, intubation and mechanical ventilation are indicated. Acetylcysteine is used for acetaminophen poisoning for up to 72 hours after ingestion. Every effort should be made to seek out the specific cause of<unk>  since specific treatments are available for some causes of<unk> . However, inappropriately prolonged investigations may make surgery impossible because of progression of sepsis and multiorgan failure. The candidates for<unk>  transplantation should be identified as quickly as possible because the progression to multiorgan failure results in deterioration in many patients who are awaiting<unk>  transplantation. While many people who develop<unk>  recover with supportive treatment,<unk>  transplantation is often required in people who continue to deteriorate or have poor prognostic factors. Effective measures for the primary prevention of<unk>  include vaccination, proper personal hygiene, maintaining proper body weight, taking precautions while handling needles, blood, body piercing, tattooing and sexual practices. Effective measures for secondary prevention of<unk>  include management of chronic<unk>  disease and its complications.
Acute liver failure
Acute renal failure
Acute kidney failure
Acute kidney injury
Hepatic failure
Hepatic encephalopathy
Water intoxication
Hepatopulmonary syndrome