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Acute liver failure is loss of liver function that occurs rapidly — in days or weeks —usually in a person who has no pre-existing liver disease. Acute liver failure is less common than chronic liver failure, which develops more slowly.

Acute liver failure, also known as fulminant hepatic failure, can cause serious complications, including excessive bleeding and increasing pressure in the brain. It’s a medical emergency that requires hospitalization.

Depending on the cause, acute liver failure can sometimes be reversed with treatment. In many situations, though, a liver transplant may be the only cure.

Symptoms of Acute Liver Failure

Signs and symptoms of acute liver failure may include:

Yellowing of your skin and eyeballs (jaundice)

Pain in your upper right abdomen

Abdominal swelling

Nausea

Vomiting

A general sense of feeling unwell (malaise)

Disorientation or confusion

Sleepiness

Causes of Acute Liver Failure

Acute liver failure occurs when liver cells are damaged significantly and are no longer able to function. Potential causes include:

Acetaminophen overdose. Taking too much acetaminophen (Tylenol, others) is the most common cause of acute liver failure in the United States. Acute liver failure can occur after one very large dose of acetaminophen, or after higher than recommended doses every day for several days.

Prescription medications. Some prescription medications, including antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants, can cause acute liver failure.

Herbal supplements. Herbal drugs and supplements, including kava, ephedra, skullcap and pennyroyal, have been linked to acute liver failure.

Hepatitis and other viruses. Hepatitis A, hepatitis B and hepatitis E can cause acute liver failure. Other viruses that can cause acute liver failure include Epstein-Barr virus, cytomegalovirus and herpes simplex virus.

Toxins. Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for edible species.

Autoimmune disease. Liver failure can be caused by autoimmune hepatitis — a disease in which your immune system attacks liver cells, causing inflammation and injury.

Diseases of the veins in the liver. Vascular diseases, such as Budd-Chiari syndrome, can cause blockages in the veins of the liver, leading to acute liver failure.

Metabolic disease. Rare metabolic diseases, such as Wilson’s disease and acute fatty liver of pregnancy, infrequently cause acute liver failure.

Cancer. Cancer that either begins in or spreads to your liver can cause your liver to fail.

Many cases of acute liver failure have no apparent cause.

Tests and Diagnosis

Tests and procedures used to diagnose acute liver failure include:

Blood tests. Blood tests to determine how well your liver is functioning may include the prothrombin time test, which measures how long it takes your blood to clot. With acute liver failure, blood won’t clot as quickly as it should.

Imaging tests. Your doctor may recommend imaging tests, such as ultrasound, to evaluate your liver. Imaging tests may show liver damage and may help your doctor determine the cause of your liver problems.

Examination of liver tissue. Your doctor may recommend a procedure to remove a small piece of liver tissue (liver biopsy). Tests of the liver tissue may help your doctor understand why your liver is failing.

Because people with acute liver failure are at risk of bleeding during biopsy, the doctor may perform a transjugular liver biopsy. Through a tiny incision on the right side of your neck, your doctor passes a thin tube (catheter) into a large vein in your neck, through your heart and into a vein exiting your liver. Your doctor then inserts a needle down through the catheter and retrieves a sample of liver tissue.

Medications

People with acute liver failure are often treated in the intensive care unit of a hospital —and when possible, in a facility that can perform a liver transplant if necessary. Your doctor may try to treat the liver damage itself, but in many cases, treatment involves controlling complications and giving your liver time to heal.

Treatments for acute liver failure

Acute liver failure treatments may include:

Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin and may reduce liver damage.

Liver transplant. When acute liver failure can’t be reversed, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes your damaged liver and replaces it with a healthy liver from a donor.

Treatments for complications

Your doctor will work to control signs and symptoms you’re experiencing and try to prevent complications caused by acute liver failure. This care may include:

Relieving pressure caused by excess fluid in the brain. Cerebral edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the fluid buildup in your brain.

Screening for infections. Your medical team will take periodic samples of your blood and urine to be tested for infection. If your doctor suspects that you have an infection, you’ll receive medications to treat the infection.

Preventing severe bleeding. Your doctor can give you medications to reduce the risk of bleeding. If you lose a lot of blood, your doctor may perform tests to find the source of the blood loss, and you may require blood transfusions.

Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate, and your blood’s chemical makeup may get out of balance.

Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly over a few hours or a few days. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care.

Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you’re otherwise in good health, you may recover normal or nearly normal kidney function.

Symptoms of Acute kidney failure

Signs and symptoms of acute kidney failure may include:

Decreased urine output, although occasionally urine output remains normal

Fluid retention, causing swelling in your legs, ankles or feet

Drowsiness

Shortness of breath

Fatigue

Confusion

Nausea

Seizures or coma in severe cases

Chest pain or pressure

Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason.

Causes of Acute kidney failure

Acute kidney failure can occur when:

You have a condition that slows blood flow to your kidneys

You experience direct damage to your kidneys

Your kidneys’ urine drainage tubes (ureters) become blocked and wastes can’t leave your body through your urine

Impaired blood flow to the kidneys

Diseases and conditions that may slow blood flow to the kidneys and lead to kidney failure include:

Blood or fluid loss

Blood pressure medications

Heart attack and  Heart disease

Infection

Liver failure

Use of aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others) or related drugs

Severe allergic reaction (anaphylaxis)

Severe burns

Severe dehydration

Damage to the kidneys

These diseases, conditions and agents may damage the kidneys and lead to acute kidney failure:

Blood clots in the veins and arteries in and around the kidneys

Cholesterol deposits that block blood flow in the kidneys

Glomerulonephritis  inflammation of the tiny filters in the kidneys (glomeruli)

Hemolytic uremic syndrome, a condition that results from premature destruction of red blood cells

Infection

Lupus, an immune system disorder causing glomerulonephritis

Medications, such as certain chemotherapy drugs, antibiotics, dyes used during imaging tests and zoledronic acid (Reclast, Zometa), used to treat osteoporosis and high blood calcium levels (hypercalcemia)

Multiple myeloma, a cancer of the plasma cells

Scleroderma, a group of rare diseases affecting the skin and connective tissues

Thrombotic thrombocytopenic purpura, a rare blood disorder

Toxins, such as alcohol, heavy metals and cocaine

Vasculitis, an inflammation of blood vessels

Urine blockage in the kidneys

Diseases and conditions that block the passage of urine out of the body (urinary obstructions) and can lead to acute kidney failure include:

Bladder cancer

Blood clots in the urinary tract

Cervical cancer

Colon cancer

Enlarged prostate

Kidney stones

Nerve damage involving the nerves that control the bladder

Prostate cancer

Risk Factors of Acute kidney failure

Acute kidney failure almost always occurs in connection with another medical condition or event. Conditions that can increase your risk of acute kidney failure include:

Being hospitalized, especially for a serious condition that requires intensive care

Advanced age

Blockages in the blood vessels in your arms or legs (peripheral artery disease)

Diabetes

High blood pressure

Heart failure

Kidney diseases

Liver diseases

Tests and Diagnosis

If your signs and symptoms suggest that you have acute kidney failure, your doctor may recommend certain tests and procedures to verify your diagnosis. These may include:

Urine output measurements. The amount of urine you excrete in a day may help your doctor determine the cause of your kidney failure.

Urine tests. Analyzing a sample of your urine, a procedure called urinalysis, may reveal abnormalities that suggest kidney failure.

Blood tests. A sample of your blood may reveal rapidly rising levels of urea and creatinine — two substances used to measure kidney function.

Imaging tests. Imaging tests such as ultrasound and computerized tomography may be used to help your doctor see your kidneys.

Removing a sample of kidney tissue for testing. In some situations, your doctor may recommend a kidney biopsy to remove a small sample of kidney tissue for lab testing. Your doctor inserts a needle through your skin and into your kidney to remove the sample.

Treatment and Drugs

Treatment for acute kidney failure typically requires a hospital stay. Most people with acute kidney failure are already hospitalized. How long you’ll stay in the hospital depends on the reason for your acute kidney failure and how quickly your kidneys recover.

Your doctor will also work to prevent complications and allow your kidneys time to heal. Treatments that help prevent complications include:

Treatments to balance the amount of fluids in your blood. If your acute kidney failure is caused by a lack of fluids in your blood, your doctor may recommend intravenous (IV) fluids. In other cases, acute kidney failure may cause you to have too much fluid, leading to swelling in your arms and legs. In these cases, your doctor may recommend medications (diuretics) to cause your body to expel extra fluids.

Medications to control blood potassium. If your kidneys aren’t properly filtering potassium from your blood, your doctor may prescribe calcium, glucose or sodium polystyrene sulfonate (Kayexalate, Kionex) to prevent the accumulation of high levels of potassium in your blood. Too much potassium in the blood can cause dangerous irregular heartbeats (arrhythmias) and muscle weakness.

Medications to restore blood calcium levels. If the levels of calcium in your blood drop too low, your doctor may recommend an infusion of calcium.

Dialysis to remove toxins from your blood. If toxins build up in your blood, you may need temporary hemodialysis — often referred to simply as dialysis — to help remove toxins and excess fluids from your body while your kidneys heal. Dialysis may also help remove excess potassium from your body. During dialysis, a machine pumps blood out of your body through an artificial kidney (dialyzer) that filters out waste. The blood is then returned to your body.

Asthma is a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult and trigger coughing, wheezing and shortness of breath.

For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.

Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust treatment as needed.

Symptoms of Asthma

Asthma symptoms range from minor to severe and vary from person to person. You may have infrequent asthma attacks, have symptoms only at certain times — such as when exercising — or have symptoms all the time.

Asthma signs and symptoms include:

Shortness of breath

Chest tightness or pain

Trouble sleeping caused by shortness of breath, coughing or wheezing

A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children)

Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Signs that your asthma is probably worsening include:

Asthma signs and symptoms that are more frequent and bothersome

Increasing difficulty breathing (measurable with a peak flow meter, a device used to check how well your lungs are working)

The need to use a quick-relief inhaler more often

For some people, asthma symptoms flare up in certain situations:

Exercise-induced asthma, which may be worse when the air is cold and dry

Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust

Allergy-induced asthma, triggered by particular allergens, such as pet dander, cockroaches or pollen

Causes of Asthma

It isn’t clear why some people get asthma and others don’t, but it’s probably due to a combination of environmental and genetic (inherited) factors.

Asthma triggers

Exposure to various substances that trigger allergies (allergens) and irritants can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include:

Airborne allergens, such as pollen, animal dander, mold, cockroaches and dust mites

Respiratory infections, such as the common cold

Physical activity (exercise-induced asthma)

Cold air

Air pollutants and irritants, such as smoke

Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)

Strong emotions and stress

Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine

Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

Menstrual cycle in some women

Risk Factors

A number of factors are thought to increase your chances of developing asthma. These include:

Having a blood relative (such as a parent or sibling) with asthma

Having another allergic condition, such as atopic dermatitis or allergic rhinitis (hay fever)

Being overweight

Being a smoker

Exposure to secondhand smoke

Having a mother who smoked while pregnant

Exposure to exhaust fumes or other types of pollution

Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing

Exposure to allergens, exposure to certain germs or parasites, and having some types of bacterial or viral infections also may be risk factors. However, more research is needed to determine what role they may play in developing asthma.

Complications

Asthma complications include:

Symptoms that interfere with sleep, work or recreational activities

Sick days from work or school during asthma flare-ups

Permanent narrowing of the bronchial tubes (airway remodeling) that affects how well you can breathe

Emergency room visits and hospitalizations for severe asthma attacks

Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

Asthma is classified into four general categories:

Asthma classification	Signs and symptoms
Mild intermittent	Mild symptoms up to two days a week and up to two nights a month
Mild persistent	Symptoms more than twice a week, but no more than once in a single day
Moderate persistent	Symptoms once a day and more than one night a week
Severe persistent	Symptoms throughout the day on most days and frequently at night

Treatment and Drugs

Prevention and long-term control are key in stopping asthma attacks before they start. Treatment usually involves learning to recognize your triggers, taking steps to avoid them and tracking your breathing to make sure your daily asthma medications are keeping symptoms under control. In case of an asthma flare-up, you may need to use a quick-relief inhaler, such as albuterol.

Medications

The right medications for you depend on a number of things, including your age, your symptoms, your asthma triggers and what seems to work best to keep your asthma under control.

Preventive, long-term control medications reduce the inflammation in your airways that leads to symptoms. Quick-relief inhalers (bronchodilators) quickly open swollen airways that are limiting breathing. In some cases, allergy medications are necessary.

Long-term asthma control medications, generally taken daily, are the cornerstone of asthma treatment. These medications keep asthma under control on a day-to-day basis and make it less likely you’ll have an asthma attack. Types of long-term control medications include:

Inhaled corticosteroids. These anti-inflammatory drugs include fluticasone (Flovent HFA), budesonide (Pulmicort Flexhaler), flunisolide (Aerobid), ciclesonide (Alvesco), beclomethasone (Qvar) and mometasone (Asmanex).

You may need to use these medications for several days to weeks before they reach their maximum benefit. Unlike oral corticosteroids, these corticosteroid medications have a relatively low risk of side effects and are generally safe for long-term use.

Leukotriene modifiers. These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms for up to 24 hours. In rare cases, these medications have been linked to psychological reactions, such as agitation, aggression, hallucinations, depression and suicidal thinking. Seek medical advice right away for any unusual reaction.

Long-acting beta agonists. These inhaled medications, which include salmeterol (Serevent) and formoterol (Foradil, Perforomist), open the airways. Some research shows that they may increase the risk of a severe asthma attack, so take them only in combination with an inhaled corticosteroid. And because these drugs can mask asthma deterioration, don’t use them for an acute asthma attack.

Combination inhalers. These medications — such as fluticasone-salmeterol (Advair Diskus), budesonide-formoterol (Symbicort) and mometasone-formoterol (Dulera) — contain a long-acting beta agonist along with a corticosteroid. Because these combination inhalers contain long-acting beta agonists, they may increase your risk of having a severe asthma attack.

Theophylline. Theophylline (Theo-24, Elixophyllin, others) is a daily pill that helps keep the airways open (bronchodilator) by relaxing the muscles around the airways. It’s not used as often now as in past years.

Quick-relief (rescue) medications are used as needed for rapid, short-term symptom relief during an asthma attack — or before exercise if your doctor recommends it. Types of quick-relief medications include:

Short-acting beta agonists. These inhaled, quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack. They include albuterol (ProAir HFA, Ventolin HFA, others), levalbuterol (Xopenex) and pirbuterol (Maxair). Short-acting beta agonists can be taken using a portable, hand-held inhaler or a nebulizer — a machine that converts asthma medications to a fine mist — so that they can be inhaled through a face mask or a mouthpiece.

Ipratropium (Atrovent). Like other bronchodilators, ipratropium acts quickly to immediately relax your airways, making it easier to breathe. Ipratropium is mostly used for emphysema and chronic bronchitis, but it’s sometimes used to treat asthma attacks.

Oral and intravenous corticosteroids. These medications — which include prednisone and methylprednisolone — relieve airway inflammation caused by severe asthma. They can cause serious side effects when used long term, so they’re used only on a short-term basis to treat severe asthma symptoms.

If you have an asthma flare-up, a quick-relief inhaler can ease your symptoms right away. But if your long-term control medications are working properly, you shouldn’t need to use your quick-relief inhaler very often.

Keep a record of how many puffs you use each week. If you need to use your quick-relief inhaler more often than your doctor recommends, see your doctor. You probably need to adjust your long-term control medication.

Allergy medications may help if your asthma is triggered or worsened by allergies. These include:

Allergy shots (immunotherapy). Over time, allergy shots gradually reduce your immune system reaction to specific allergens. You generally receive shots once a week for a few months, then once a month for a period of three to five years.

Omalizumab (Xolair). This medication, given as an injection every two to four weeks, is specifically for people who have allergies and severe asthma. It acts by altering the immune system.

Allergy medications. These include oral and nasal spray antihistamines and decongestants as well as corticosteroid and cromolyn nasal sprays.