Key messages

• The new classification of acute liver failure (ALF) takes into account rapidity of onset and etiology as important indicators of likely progress.

• Microcirculatory dysfunction with covert tissue oxygen debt is the basis of multiple organ failure.

• Host defenses to bacterial infection are severely compromised early in the course of ALF.

• Reduction in cerebral blood flow and resultant cerebral ischemia are important in the development of cerebral edema.

• Acetaminophen (paracetamol) overdose is the most common cause of ALF in the United Kingdom. Antituberculosis drug therapy is responsible for an increasing number of cases.

• The frequency with which viral hepatitis A, B, C, D, E is the cause of ALF is related to the underlying prevalence of these infections in the country concerned. In many cases of presumed fulminant viral hepatitis, no specific agent is identifiable.

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