• Lars Marius Ytrebø and Pål Klepstad.
• Critical Care Unit, University College London Hospitals NHS Foundation Trust og Institutt for klinisk medisin, Universitetet i Tromsø, Norway. lars.m.ytrebo@uit.no
• Tidsskr. Nor. Laegeforen. 2010 Aug 26; 130 (16): 1609-13.

BackgroundAcute liver failure and acute decompensated chronic liver failure are two diseases that demand extensive knowledge of etiology and triggering factors, pathophysiology, diagnosis, prognosis and recommended guidelines for treatment. The article defines the diseases, discusses etiological factors, treatment strategies, indications for referral to the transplantation unit at Rikshospitalet and prognostic factors of importance.Material And MethodsThe basis for this article is literature identified through a non-systematic search in PubMed and the authors' clinical experience and experimental research within the field.ResultsIn the Western world paracetamol poisoning and toxic reactions to other drugs are the most common triggering factors for acute liver poisoning in adults. Patients can quickly develop multi organ failure requiring advanced intensive care. The most common complications are hepatic encephalopathy, acute renal failure and coagulation disturbances. Acute decompensated chronic liver failure strikes patients with known liver disease and is most often triggered by inflammation, infection, gastrointestinal bleeding, drugs, traumas or disturbances in acid/base/electrolyte balance. Early diagnosing of triggering factors and intensive medical supportive treatment is especially important. Acute renal failure indicates a very bad prognosis.InterpretationPatients diagnosed with acute liver failure or acute decompensated chronic liver failure remain a clinical challenge. Optimal treatment requires extensive knowledge of pathophysiological mechanisms and treatment strategies.

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