Štefan Hrušovský, Michal R. Piják, Martin Demeš, Miroslav Žigrai
Acute liver failure is a life-threatening disease. It can develop on healthy liver or on chronic liver disease (chronic hepatitis, liver cirrhosis). The disease is characterized by severe hemocoagulation impairement and symptoms of hepatic encephalopathy. The cause of acute liver failure is usually mushroom intoxication (mycetism) of cyclopeptide type (i. e., Amanita phalloides), fulminant hepatitis B and acute drug injury of the liver. Acute liver failure in case of chronic liver disease, „acute on chronic“, occurs in autoimmune hepatitis, Wilson´s disease, chronic hepatitis B. The therapeutic strategy includes liver transplantation and elilmination methods as MARS, Prometheus and others. Medicamentous treatment in mushroom intoxication uses laxatives, carbo adsorbens, high doses of crystallized penicillin G, and silybinin. Early treatment can save the patient´s life. In acetaminophen intoxication the antidote is N-acetylcystein. In acute liver failure in case of autoimmune hepatitis corticoids are effective. In Wilson´s crisis, liver transplantation if often inevitable.