Key messages

• There is no specific diagnostic test.

• Classical presentation is with jaundice, coagulopathy, and encephalopathy in the absence of previous liver disease.

• Liver function tests (apart from plasma bilirubin concentration) are of little value in the diagnosis or assessment of severity.

• Assessment involves consideration of the need to transfer the patient, determination of the cause, and assessment of prognosis.

• Both the King's College and the Clichy criteria have good positive predictive value but are unable to identify the subgroup at low risk of death.

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