Liver failure is a serious condition that can develop rapidly and lead to severe complications or death if not treated promptly. In most cases, liver failure does not occur suddenly in just one day – it often takes weeks or months to progress to complete failure. However, there are some circumstances in which a previously healthy liver can deteriorate extremely quickly, sometimes even over the course of 24 hours.
What is liver failure?
The liver is a vital organ that performs many critical functions in the body. Some of the liver’s key responsibilities include:
- Processing nutrients from food and drink
- Removing toxins from the blood
- Manufacturing proteins and enzymes needed for digestion
- Storing vitamins, minerals, and iron
- Regulating blood clotting
Liver failure occurs when the liver is no longer able to perform these functions at the level needed to sustain normal bodily processes. There are two main types of liver failure:
- Acute liver failure – when serious damage to the liver develops quickly, over days or weeks
- Chronic liver failure – when the liver slowly loses function over months or years
Acute liver failure is less common but more immediately dangerous than chronic failure. With acute failure, the liver deterioration is rapid enough to cause encephalopathy (brain dysfunction), coagulopathy (impaired blood clotting), and sometimes multi-system organ failure that can lead to death.
What causes acute liver failure?
Some potential causes of acute liver failure include:
- Medications – Overdosing on acetaminophen/paracetamol is the top cause of acute liver failure in many countries. Other prescription or herbal medications can also harm the liver.
- Viruses – Hepatitis A, B, D, and E viruses can trigger liver inflammation and failure.
- Toxins – Chemicals like carbon tetrachloride, mushroom poisons, industrial solvents.
- Autoimmune disease – Autoimmune hepatitis causes the body’s immune system to attack liver cells.
- Metabolic disorder – Disorders that impair liver metabolism, such as Wilson’s disease.
- Vascular diseases – Reduced blood flow to the liver can cause ischemic injury.
In up to 15% of cases, no clear cause is identified, and the liver failure is termed indeterminate.
How quickly can acute liver failure develop?
Acute liver failure often develops over several weeks, even when caused by a sudden insult like a drug overdose. But in some situations, a healthy liver can deteriorate to complete failure astonishingly quickly – sometimes even over 1-3 days.
The most common causes of hyperacute liver failure (developing in under 7 days) include:
- Acetaminophen overdose – taking too much acetaminophen/paracetamol at once can overwhelm liver detox pathways within a couple days.
- Hepatitis viruses – hepatitis A and B can occasionally cause liver failure within 1-2 weeks of exposure.
- Autoimmune flare – autoimmune hepatitis exacerbations or triggered episodes can rapidly attack liver cells.
- Acute fatty liver of pregnancy – a rare complication that causes massive fatty infiltration and liver damage late in pregnancy.
- Heat stroke – extreme heat stress and dehydration can trigger ischemic liver injury and failure.
- Hypoxic hepatitis – oxygen deprivation to the liver from low blood pressure, respiratory failure, etc.
While most cases of liver failure take longer than a week to develop, progression to failure within 72 hours is possible in susceptible individuals with the above conditions.
Can liver failure happen in 24 hours?
It is rare, but liver failure can occasionally progress from first symptoms to complete failure within a single 24 hour period. Some scenarios where this hyperacute progression can occur include:
- Massive acetaminophen overdose – Reports exist of liver failure occurring in under 24 hours when >25 grams of acetaminophen are ingested at once.
- Amanita phalloides mushroom poisoning – Death cap mushroom toxins can destroy liver tissue in less than a day.
- Shock liver – Ischemic hepatitis from low blood pressure can lead to massive necrosis.
- Acute viral hepatitis flare – Sudden flares of hepatitis B infection very rarely induce liver failure in <24 hrs.
- Acute fatty liver of pregnancy – Can develop immediately postpartum in susceptible individuals.
- Liver transplant rejection – Hyperacute rejection reactions can cause liver failure in a transplanted liver.
However, even in the above situations, progression from normal liver function to complete failure in under 24 hours is exceptionally rare and represents an emergency requiring urgent treatment.
Symptoms of acute liver failure
Symptoms of acute liver failure may include:
- Jaundice – yellowing skin/eyes
- Bleeding disorders – easy bruising, bloody nose
- Ascites – fluid accumulation in the abdomen
- Hepatic encephalopathy – confusion, jitteriness, coma
- Fever
- Nausea and vomiting
- Abdominal pain
When liver failure occurs rapidly, symptoms can escalate quickly from initial fatigue and nausea to debilitating encephalopathy or coma. Seeking immediate medical care is vital.
Diagnosis of acute liver failure
Acute liver failure may be diagnosed through:
- Physical exam – assessing jaundice, encephalopathy, fever
- Lab tests – elevated bilirubin, INR, liver enzymes confirm liver injury and dysfunction
- Imaging – CT or MRI scans help exclude other potential causes
- Liver biopsy – not always necessary but can help determine cause
The exact criteria for diagnosing acute liver failure differs between guidelines but generally includes:
- Onset of liver injury fewer than 26 weeks ago
- Serum bilirubin > 3.0 mg/dL
- INR ≥ 1.5
- Hepatic encephalopathy
Meeting these thresholds indicates severe, life-threatening liver damage.
Prognosis and treatment
The prognosis for someone with acute liver failure depends significantly on:
- Cause – Toxin/drug-induced has better prognosis than infectious causes
- Speed of progression – Failure over weeks is less dangerous than over days
- Presence of complications – Bleeding, sepsis, kidney failure worsen prognosis
- Degree of encephalopathy – Mild is better than deep coma
- General health – Younger, healthier patients have improved survival
Even with treatment, mortality rates for acute liver failure range from 15-95%. Fulminant hepatic failure with encephalopathy has over 50% mortality.
Treatment focuses on identifying the cause, providing supportive critical care, and managing complications. Definitive treatment is often liver transplantation if failure persists. With proper intensive care, patients with acute liver failure may recover without transplantation.
Key Takeaways
- Acute liver failure is rare but involves a rapid deterioration of liver function that can become life-threatening.
- Progression to acute liver failure typically takes weeks or more, but can uncommonly happen within 1-3 days.
- Liver failure within 24 hours is extremely rare but can occur with massive acetaminophen overdose, viruses, ischemic insult, or acute rejection of a transplanted liver.
- Rapid onset liver failure requires emergency evaluation and intensive care to try to prevent complications leading to death or need for liver transplant.
Conclusion
While complete liver failure within a 24 hour period is very rare, it is possible in certain circumstances. However, even rapid deterioration of liver function over several days is considered an emergency requiring prompt evaluation and treatment. Early recognition of symptoms, identification of the cause, and initiation of supportive care provide the best chances for recovery and survival for patients with this high-risk condition.