19th May 2025

Acute Liver Failure

Approximately 4% of case idiosyncratic DILI progress to acute liver failure (ALF). Factors increasing the likelihood of developing ALF include hepatocellular DILI and female gender. 

The most common drugs responsible for DILI which progresses to ALF include anti-tuberculosis medications, herbal/complementary medicines and dietary supplements, co-amoxiclav, nitrofurantoin, sulfa-based drugs, phenytoin and valproate. 

In cases of drug-induced ALF, early discussion regarding liver transplantation is crucial as survival without transplant is poor (27% at 3 weeks). Evidence suggests steroids confer little survival benefit in ALF.