Key points from this Chest review:
Classification of acute liver failure (ALF) based on its time course (hyperacute, acute, subacute) is useful in anticipating the etiology, prognosis and expected complications.
APAP is the most common etiologic factor.
The APAP toxicity nomogram is unreliable in many circumstances.
Infection is common in ALF and may precipitate cerebral edema. Daily surveillance cultures are recommended and empiric broad spectrum antibiotics are recommended in some subgroups.
The risk or cerebral edema rises in proportion to the rapidity of development of ALF due to the time required for cerebral adaptive mechanisms.
There is a relative lack of high level evidence to guide treatment. A summary is provided.