Acute Liver Failure Differential Diagnoses

  • Author: Gagan K Sood, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Mar 29, 2011
 
 

Diagnostic Considerations

A wide variety of conditions can cause acute liver failure or produce mental status changes and coagulopathy resembling acute liver failure. Problems to consider include the following:

  • Acute fatty liver of pregnancy
  • Amanita phalloides mushroom poisoning
  • Bacillus cereus toxin
  • Fructose intolerance
  • Galactosemia
  • HELLP syndrome of pregnancy
  • Hemorrhagic viruses (Ebola virus, Lassa virus, Marburg virus)
  • Idiopathic drug reaction (hypersensitivity)
  • Neonatal iron storage disease
  • Tyrosinemia
  • Acetaminophen poisoning

For a discussion of acute liver failure and other diagnostic considerations in liver transplant recipients, see the eMedicine article Liver Transplants.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Gagan K Sood, MD  Associate Professor, Department of Medicine and Surgery, Baylor College of Medicine

Gagan K Sood, MD is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Steven A Conrad, MD, PhD  Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center

Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Lemi Luu, MD  Attending Physician, Department of Emergency Medicine, Washington Hospital Center, Georgetown University School of Medicine

Lemi Luu, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mark S Slabinski, MD, FACEP, FAAEM  Vice President, EMP Medical Group

Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association

Disclosure: Nothing to disclose.

Carin M Van Gelder, MD  Assistant Professor, Department of Emergency Medicine, Yale University; EMS Medical Director, NHSHP and EMS Physician, SHARP Team; Attending Physician, Emergency Medicine, Yale-New Haven Medical Center

Carin M Van Gelder, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Massachusetts Medical Society, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David Eric Bernstein, MD  Director of Hepatology, North Shore University Hospital, Professor of Clinical Medicine, Albert Einstein College of Medicine

David Eric Bernstein, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Oscar S Brann, MD, FACP  Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group

Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

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  16. Schiødt FV, Rossaro L, Stravitz RT, Shakil AO, Chung RT, Lee WM. Gc-globulin and prognosis in acute liver failure. Liver Transpl. Oct 2005;11(10):1223-7. [Medline].

  17. Rolando N, Harvey F, Brahm J, Philpott-Howard J, Alexander G, Casewell M, et al. Fungal infection: a common, unrecognised complication of acute liver failure. J Hepatol. Jan 1991;12(1):1-9. [Medline].

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  22. [Guideline] Murray KF, Carithers RL Jr. AASLD practice guidelines: Evaluation of the patient for liver transplantation. Hepatology. Jun 2005;41(6):1407-32. [Medline].

  23. AASLD position paper: the management of acute liver failure. Private Nonprofit Research Organization. American Association for the Study of Liver Diseases - Private Nonprofit Research Organization. May 2005;36(1):19 pages.

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  27. Demetriou AA, Brown RS Jr, Busuttil RW, Fair J, McGuire BM, Rosenthal P, et al. Prospective, randomized, multicenter, controlled trial of a bioartificial liver in treating acute liver failure. Ann Surg. May 2004;239(5):660-7; discussion 667-70. [Medline]. [Full Text].

  28. ClinicalTrials.gov. The Effect of Prometheus (R) Liver Support Dialysis on Cerebral Metabolism in Acute Liver Failure. Available at http://clinicaltrials.gov/ct2/show/NCT00655304.

 
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Table. Grading of Hepatic Encephalopathy
Grade Level of Consciousness Personality and Intellect Neurologic Signs Electroencephalogram (EEG) Abnormalities
0NormalNormalNoneNone
SubclinicalNormalNormalAbnormalities only on psychometric testingNone
1Day/night sleep reversal, restlessnessForgetfulness, mild confusion, agitation, irritabilityTremor, apraxia, incoordination, impaired handwritingTriphasic waves (5 Hz)
2Lethargy, slowed responsesDisorientation to time, loss of inhibition, inappropriate behaviorAsterixis, dysarthria, ataxia, hypoactive reflexesTriphasic waves (5 Hz)
3Somnolence, confusionDisorientation to place, aggressive behaviorAsterixis, muscular rigidity, Babinski signs, hyperactive reflexesTriphasic waves (5 Hz)
4ComaNoneDecerebrationDelta/slow wave activity
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