Acute liver failure causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:  Husnain Shaukat, M.D [2]

## Overview

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The causes of acute liver failure can be categorized into viral, drugs and toxins, vascular, and metabolic. Common causes of acute liver failure include acetaminophen toxicity, viral hepatitis (most commonly hepatitis A, hepatitis B and hepatitis E), alcoholic hepatitis, autoimmune, sepsis, right heart failure, and idiopathic. Acetaminophen toxicity is the most common cause of acute liver failure in the developed world and viral hepatitis (most commonly hepatitis A, hepatitis B and hepatitis E) is most common in the developing world.

## Causes

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### Common Causes

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The common causes of acute liver failure are:[1][2][3][4][2][5]

* Acetaminophen overdose, the reason is usually suicidal intent. Additionally, the toxic threshold dose of acetaminophen decreases in some cases, such as in chronic alcoholics, diabetics, and while fasting. Drug-induced acute liver failure is the most common cause in the developed world. It is responsible for more than 50% of the cases of acute liver failure in the United States.
* Idiosyncratic reactions to medications such as tetracycline, troglitazone, antituberculosis drugs, and anti-epileptic drugs
* Viral hepatitis (hepatitis A, B and hepatitis E) are the most common. The incidence of acute liver failure in post-viral hepatitis has decreased due to the vaccination and improved sanitation in the developed world. However, it is still the most common cause in the developing world.
* Alcohol
* Autoimmune hepatitis
* Acute fatty liver of pregnancy
* Reye syndrome
* Wilson's disease
* Idiopathic (without an obvious cause)
* Diseases of fatty acid oxidation pathways
* Parvovirus B19 infection
* Budd–Chiari syndrome
* Malignancy such as lymphomas
* Shock
* Sepsis
* Hyperthermia
* Hypothermia
* HELP syndrome

### Causes by Organ System

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Cardiovascular | Cardiomyopathy, Congestive heart failure, Heart surgery, Hypoplastic left heart syndrome, Hypotension, Myocarditis, Shock

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Chemical / poisoning | 8-Hyydroxyquinoline, Amanita phalloides, Amatoxins, Carbon tetrachloride, Ethanol, Gold, Gyromitrin, Iron compounds, Mushroom poisoning, Senecio, Toluene, Yellow phosphorous, Bacillus cereus  , Cyanobacteria
Dermatologic | No underlying causes
Drug Side Effect | Abacavir, Acetaminophen, Acetaminophen and Oxycodone, Albendazole, Allopurinol, Amiodarone, Amitriptyline, Ampicillin, Amoxicillin-clavulanate, Anticonvulsants, Antituberculosis drugs, Aspirin, Atorvastatin, Bromfenac  , Carbamazepine, Chaparral, Chelidonium, Ciprofloxacin, Comfrey, Cyclophosphamide, Dantrolene, Dapsone, diclofenac (patch), Didanosine, Dideoxyinosine, Disulfiram, Doxycycline, Efavirenz, Ephedra, Erlotinib, Erythromycin, Etodolac, Fluoroquinolones, Flutamide, Gemtuzumab, Gemtuzumab, Germander tea, Ginseng, Halothane, He Shou Wu, Hydroxychloroquine, Imipramine, Interferon beta, Isoflurane, Isoniazid, Ixabepilone, Kava kava, Ketoconazole, Labetalol, Leflunomide, Loratadine, Lovastatin, Ma Huang, MAO inhibitors, Meloxicam, Methotrexate, Methyldopa, Moxifloxacin, Niacin, Nevirapine, Nicotinic acid, Nitisinone, Nitrofurantoin, Nortriptyline, NSAIDs, Oral contraceptive pills  , Pazopanib, Pemoline, Pennyroyal, Phenytoin, Propylthiouracil, Pyrazinamide, Regorafenib, Rifampin, Simvastatin, Skull cap, Statins, Sulfacetamide, Sulfasalazine, Suloctidil, Terbinafine, Tetracycline, Teucrium polium, Tolcapone, Tricyclic antidepressants, Troglitazone, Valproic acid, Ecstacy, Cocaine, Reye's syndrome
Ear Nose Throat | No underlying causes
Endocrine | No underlying causes
Environmental | No underlying causes
Gastroenterologic | Budd-Chiari syndrome, Cirrhosis, Hepatic arterial thrombosis, Hepatic veno-occlusive disease, Ischemic hepatitis, Portal vein thrombosis, Alpha1-antitrypsin deficiency, Acute fatty liver of pregnancy, Liver tumor, Autoimmune hepatitis
Genetic | Alpha1-antitrypsin deficiency, Carnitine palmitoyltransferase 1 deficiency, Fructose intolerance, Galactosemia, Hemochromatosis, LCAT deficiency, Sickle cell disease, Tyrosinemia, Wilson's disease, HELLP syndrome
Hematologic | Hemosiderosis, Hemochromatosis, Sickle cell disease, HELLP syndrome, Leukemia
Iatrogenic | Extracorporeal membrane oxygenation, Hepatectomy, Reye's syndrome
Infectious Disease | Adenovirus, Bacillus cereus  , Cyanobacteria, Cytomegalovirus, Echovirus, Epstein-Barr virus, Fasciola hepatica, Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, Herpes simplex, Leptospirosis, Non A non B hepatitis  , Parainfluenza viruses, Parvovirus, Sepsis, Viral hemorrhagic fever, Viral hepatitis, Visceral leishmaniasis
Musculoskeletal / Ortho | Adult onset Still's disease
Neurologic | No underlying causes
Nutritional / Metabolic | Fatty acid oxidation pathway diseases, Hemochromatosis, Carnitine palmitoyltransferase 1 deficiency, Fructose intolerance, Galactosemia, LCAT deficiency, Tyrosinemia, Wilson's disease
Obstetric/Gynecologic | Acute fatty liver of pregnancy, HELLP syndrome
Oncologic | Leukemia, Liver tumor
Opthalmologic | No underlying causes
Overdose / Toxicity | Abacavir, Acetaminophen, Allopurinol, Amiodarone, Amitriptyline, Ampicillin, Amoxicillin-clavulanate, Anticonvulsants, Antituberculosis drugs, Aspirin, Atorvastatin, Bromfenac  , Carbamazepine, Chaparral, Chelidonium, Ciprofloxacin, Comfrey, Cyclophosphamide, Dantrolene, Dapsone, Didanosine, Dideoxyinosine, Disulfiram, Doxycycline, Efavirenz, Ephedra, Erlotinib, Erythromycin, Etodolac, Fluoroquinolones, Flutamide, Gemtuzumab, Gemtuzumab, Germander tea, Ginseng, Halothane, He Shou Wu, Imipramine, Interferon beta, Isoflurane, Isoniazid, Kava kava, Ketoconazole, Labetalol, Leflunomide, Lovastatin, Ma Huang, MAO inhibitors, Methotrexate, Methyldopa, Moxifloxacin, Nevirapine, Nicotinic acid, Nitisinone, Nitrofurantoin, Nortriptyline, NSAIDs, Oral contraceptive pills  , Pazopanib, Pemoline, Pennyroyal, Phenytoin, Propylthiouracil, Pyrazinamide, Regorafenib, Rifampin, Simvastatin, Skull cap, Statins, Sulfasalazine, Suloctidil, Terbinafine, Tetracycline, Teucrium polium, Tolcapone, Tricyclic antidepressants, Troglitazone, Valproic acid, Ecstacy, Cocaine
Psychiatric | No underlying causes
Pulmonary | Asphyxia, Alpha1-antitrypsin deficiency
Renal / Electrolyte | No underlying causes
Rheum / Immune / Allergy | Autoimmune hepatitis, Graft versus host disease
Sexual | No underlying causes
Trauma | No underlying causes
Urologic | No underlying causes
Dental | No underlying causes
Miscellaneous | Alcohol, Cocaine, Cryptogenic, Ecstacy, Heat stroke, Hyperthermia, Hypothermia

### Causes in Alphabetical Order

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* 8-Hyydroxyquinoline
* Abacavir
* Acetaminophen
* Acute fatty liver of pregnancy
* Adenovirus
* Adult onset Still's disease
* Alcohol
* Allopurinol
* Alpha1-antitrypsin deficiency
* Amanita phalloides
* Amatoxins
* Amiodarone
* Amitriptyline
* Amoxicillin-clavulanate
* Ampicillin
* Anticonvulsants
* Antituberculosis drugs
* Asphyxia
* Aspirin
* Atorvastatin
* Autoimmune hepatitis
* Bacillus cereus
* Bromfenac
* Budd-Chiari syndrome
* Carbamazepine
* Carbon tetrachloride
* Cardiomyopathy
* Carnitine palmitoyltransferase 1 deficiency
* Chaparral
* Chelidonium
* Ciprofloxacin
* Cirrhosis
* Cocaine
* Comfrey
* Congestive heart failure
* Cryptogenic
* Cyanobacteria
* Cyclophosphamide
* Cytomegalovirus
* Dantrolene
* Dapsone
* Didanosine
* Dideoxyinosine
* Disulfiram
* Doxycycline
* Echovirus
* Ecstacy
* Efavirenz
* Ephedra
* Epstein-Barr virus
* Erlotinib
* Erythromycin
* Ethanol
* Etodolac
* Extracorporeal membrane oxygenation
* Fasciola hepatica
* Fatty acid oxidation pathway diseases
* Fluoroquinolones
* Flutamide
* Fructose intolerance
* Galactosemia
* Gemtuzumab
* Gemtuzumab
* Germander tea
* Ginseng
* Gold
* Graft versus host disease
* Gyromitrin
* Halothane
* He Shou Wu
* Heart surgery
* Heat stroke
* HELLP syndrome
* Hemochromatosis
* Hemosiderosis
* Hepatectomy
* Hepatic arterial thrombosis
* Hepatic veno-occlusive disease
* Hepatitis A
* Hepatitis B
* Hepatitis C
* Hepatitis D
* Herpes simplex
* Hyperthermia
* Hypoplastic left heart syndrome
* Hypotension
* Hypothermia
* Imipramine
* Interferon beta
* Iron compounds
* Ischemic hepatitis
* Isoflurane
* Isoniazid
* Ixabepilone
* Kava kava
* Ketoconazole
* Labetalol
* LCAT deficiency
* Leflunomide
* Leptospirosis
* Leukemia
* Liver tumor
* Loratadine
* Lovastatin
* Ma Huang
* MAO inhibitors
* Meloxicam
* Methotrexate
* Methyldopa
* Moxifloxacin
* Mushroom poisoning
* Myocarditis
* Nevirapine
* Niacin
* Nicotinic acid
* Nitisinone
* Nitrofurantoin
* Non A non B hepatitis
* Nortriptyline
* NSAIDs
* Oral contraceptive pills
* Parainfluenza viruses
* Parvovirus
* Pazopanib
* Pemoline
* Pennyroyal
* Phenytoin
* Portal vein thrombosis
* Propylthiouracil
* Pyrazinamide
* Regorafenib
* Reye's syndrome
* Rifampin
* Senecio
* Sepsis
* Shock
* Sickle cell disease
* Simvastatin
* Skull cap
* Statins
* Sulfasalazine
* Suloctidil
* Terbinafine
* Tetracycline
* Teucrium polium
* Tolcapone
* Toluene
* Tricyclic antidepressants
* Troglitazone
* Tyrosinemia
* Valproic acid
* Viral hemorrhagic fever
* Viral hepatitis
* Visceral leishmaniasis
* Wilson's disease
* Yellow phosphorous

## References

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1. ↑ Ichai P, Samuel D (2008). "Etiology and prognosis of fulminant hepatitis in adults". Liver Transpl. 14 Suppl 2: S67–79. doi:10.1002/lt.21612. PMID 18825677.
2. ↑ 2.0 2.1 Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Ann. Intern. Med. 137 (12): 947–54. PMID 12484709.
3. ↑ Hoofnagle JH, Nelson KE, Purcell RH (2012). "Hepatitis E." N Engl J Med. 367 (13): 1237–44. doi:10.1056/NEJMra1204512. PMID 23013075.CS1 maint: Multiple names: authors list (link)
4. ↑ Wasley A, Fiore A, Bell BP (2006). "Hepatitis A in the era of vaccination". Epidemiol Rev. 28: 101–11. doi:10.1093/epirev/mxj012. PMID 16775039.CS1 maint: Multiple names: authors list (link)
5. ↑ Björnsson E, Olsson R (2005). "Outcome and prognostic markers in severe drug-induced liver disease". Hepatology. 42 (2): 481–9. doi:10.1002/hep.20800. PMID 16025496.

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