Acute liver failure causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

There are various causes that can lead to the development of acute liver failure, the most common of which is acetaminophen overdose, usually as a consequence of attempted suicide. Other toxins such as alcohol, poisonous mushrooms, and other medications can also lead to the development of acute liver failure. It can also be idiopathic, or as a consequence of other diseases or conditions such as; Wilson's disease, autoimmune hepatitis, Reye syndrome, viral hepatitis, parvovirus B19 infection, and acute fatty liver of pregnancy.

Causes

Common Causes

• Acetaminophen overdose is the most common cause. 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.
• Idiosyncratic reactions to medication is the second most common cause. Culprit drugs are: tetracycline, troglitazone, antituberculosis drugs, and anti-epileptic drugs
• Excessive alcohol intake and severe alcoholic hepatitis
• Viral hepatitis (hepatitis A or B). The incidences of acute liver failure in post-viral hepatitis has decreased due to the extensive vaccination against these infections.
• Autoimmune hepatitis
• Acute fatty liver of pregnancy
• Reye syndrome is acute liver failure in a child with a viral infection (e.g. chickenpox); it appears that aspirin use may play a significant role
• Wilson's disease (hereditary copper accumulation) may infrequently present with acute liver failure
• Idiopathic (without an obvious cause)
• Diseases of fatty acid oxidation pathways
• Parvovirus B19 infection
• Budd–Chiari syndrome
• Malignancy such as lymphomas
• Shock
• Hyperthermia
• Hypothermia

Causes by Organ System

Cardiovascular	Cardiomyopathy, Congestive heart failure, Heart surgery, Hypoplastic left heart syndrome, Hypotension, Myocarditis, Shock
Chemical / poisoning	8-Hyydroxyquinoline, Amanita phalloides, Amatoxins, Carbon tetrachloride, Ethanol, Gold, Gyromitrin, Iron compounds, Mushroom poisoning, Senecio, Toluene, Yellow phosphorous
Dermatologic	No underlying causes
Drug Side Effect	Abacavir, Acetaminophen, Allopurinol, Amiodarone, Amitriptyline, Ampicillin, Ampicillin-clavulanate, Anticonvulsants, Antitubercular 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
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	Abacavir, Acetaminophen, Allopurinol, Amiodarone, Amitriptyline, Ampicillin, Ampicillin-clavulanate, Anticonvulsants, Antitubercular 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
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

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 Ampicillin Ampicillin-clavulanate Anticonvulsants Antitubercular 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 Kava kava Ketoconazole Labetalol LCAT deficiency Leflunomide Leptospirosis Leukemia Liver tumor Lovastatin

Ma Huang MAO inhibitors Methotrexate Methyldopa Moxifloxacin Mushroom poisoning Myocarditis Nevirapine 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