by Katherine Brind’Amour, PhD
Liver failure occurs when your liver, a vital producer of proteins for the body and an important filter of wastes, slows or stops working because of disease, malnutrition, infection or harmful chemicals, including drugs. The liver makes bile (fluid that aids in breaking down fats), stores fat and sugar as energy for the body and changes harmful substances in the body to less toxic ones. The liver also helps to control the amount of blood in the body.
What Is Liver Failure?
When liver function slows down because large portions of your liver are damaged, the body goes into a crisis mode called liver failure. Liver failure can put your body at risk, but in some cases, the liver may recover. Other cases may require a transplant if medical treatments don’t work.
In chronic liver failure, the liver starts to lose function over months and years. Liver disease can turn into liver failure over time.
In acute liver failure, the liver fails suddenly, sometimes in the course of a day or two. (1)
How long you live with liver failure depends on getting the best treatment you can as early as you can. Some people do die of liver conditions such as cirrhosis, which kills 31,000 people each year in the United States. Cirrhosis is a gradual disease. Sometimes liver failure comes on suddenly and may kill suddenly. When all treatments fail, however, liver transplants may be able to help some people recover.
Signs & Symptoms
Hepatic failure, another term for liver failure, may be hard to diagnose. Signs of liver failure can vary or be linked with other diseases. Liver failure stages fall into early signs and late signs. There is overlap in the symptoms of chronic versus acute liver failure.
Chronic Liver Failure
Early symptoms of liver disease or liver failure include: (2)
- Nausea — a liver that’s not working well can affect the digestive system and make you feel like you are going to vomit
- Loss of appetite
- Weight loss — if you feel nauseated, have no appetite or you have diarrhea, you may lose weight
- Fatigue — you may feel like you don’t have enough energy to pursue your regular activities
Later symptoms of liver failure include: (2)
- Bruising or bleeding easily — as liver function declines, you may start bleeding very easily or may notice stomach bleeding
- Jaundice — yellowish coloring in your skin and eyes
- Itching — can occur because of bile products building up in the skin or bile flow blockage (3)
- Edema, or fluid buildup in the legs — liver failure from advanced scarring, called cirrhosis, can lead to excess fluid building up in your body. It may appear in your legs because the liver isn’t functioning properly
- Ascites, or fluid buildup in the abdomen
Acute Liver Failure
Signs and symptoms of acute liver failure come on suddenly and may include: (2)
- Yellowing of your skin and eyeballs (jaundice)
- Upper right abdominal pain
- Abdominal swelling (ascites)
- Malaise, or a general sense of not feeling well
- Disorientation or confusion (also called hepatic encephalopathy)
Causes & Risk Factors
Chronic Liver Failure Causes
- Cirrhosis — This is a disease of advanced scarring in the liver. This means that large parts of the liver are unable to do their job after a long bout of fibrosis, scarring that affects liver tissue. Cirrhosis may come in a disease progression, for example, from fatty liver disease, to alcoholic hepatitis (or not), to cirrhosis. Cirrhosis of the liver symptoms are similar to those of other types of liver failure, often with internal bleeding. (4) Drinking alcohol, getting hepatitis (see below in this list) and having fat accumulate in the liver can cause cirrhosis in the long run.
- Hemochromatosis — This is an inherited disorder. The body absorbs too much iron from food, and then stores too much iron. The extra iron can cause damage to the liver and other organs, because the body has no way to flush out the extra iron. You may have hemochromatosis if you have gene mutations or you have chronic liver disease (from hepatitis C or drinking too much), frequent blood transfusions, or are on dialysis. (5)
- Hepatitis B — This a form of a viral infection that can be treated. Your body may take a few months to fight it and you will be immune after that; you cannot get hepatitis B again. Get tested for any form of hepatitis if you think you have been exposed.
- Hepatitis C — Another form of hepatitis. Most people who get hepatitis C develop a long-term condition called chronic hepatitis C. This can lead to liver problems and is a top reason for liver transplants.
- Alcohol poisoning — Drinking too much over a long-time period hurts the liver, which cannot keep processing alcohol.
- Malnutrition — Over time, people with liver disease may see appetite decline. They may get a lot of their calories from alcoholic beverages instead of good foods.
Acute Liver Failure Causes
- Several hepatitis viruses — Hepatitis A, B and C can cause acute liver failure (especially in children). Hepatitis E can also cause liver failure. (6)
- Acetaminophen overdose — Acetaminophen is an over-the-counter (nonprescription) drug that when taken in too large a dose can cause liver damage and even acute liver failure.
- Prescription drug and herbal medication reactions. Substances that may cause liver failure include: (7)
- Antibiotics like amoxicillin, clindamycin, and erythromycin
- Anticonvulsants like carbamazepine and phenobarbital
- Antidepressants like bupropion, trazodone and fluoxetine
- Antifungal drugs
- Antihypertensive drugs (lower blood pressure) like captotpril and enalapril
- Antipsychotic drugs like chloropromazine and risperidone
- Heart drugs like amiodarone and clopidogrel
- Hormones like anabolic steroids and birth control pills
- Other drugs like allopurinol to treat gout, baclofen to relax muscles or methotrexate to treat cancer
- Medicinal herbs like germander, green tea extract and kava
- Certain dietary supplements, like thermogenic supplements, which increase heat production inside the body so body fat is used for energy
- Poisonous mushrooms — Some mushrooms can cause immediate problems for the liver. It’s a very rare cause of acute liver failure (8)
Several conditions can set the liver on a path toward organ failure. Again, the causes are different for chronic failure versus acute failure.
In general, risk factors for the disease may include:
- A genetic condition called hemochromatosis
- Viral infections (especially hepatitis viruses)
- Poor diet
- Ingestion of substances that can harm the liver
- Fat buildup in the liver, or nonalcoholic fatty liver disease. These conditions can lead to deposits of fat in the liver:
- Your cells don’t take up sugar in response to the hormone insulin
- High blood sugar (hyperglycemia), indicating prediabetes or actual type 2 diabetes
- Overweight or obesity
- High levels of fats, particularly triglycerides, in your blood
Diagnosis & Conventional Treatment
A medical professional sometimes will have to check you thoroughly and ask questions to get a diagnosis of liver failure. It can be diagnosed through blood tests, liver biopsy (small slice is removed and examined), or a CT scan, MRI or ultrasound imaging.
For chronic liver failure treatment, patients may have differing treatments depending on the liver failure causes and type of chronic liver failure they have:
- Cirrhosis may require draining of ascites (fluid).
- Hepatitis may mean certain drugs or drug combinations are needed to fight the infection. Patients may be hospitalized.
- Hemochromatosis is treated with regular periods of blood removal and chelation to take out extra iron.
- Alcoholic hepatitis treatments include drinking cessation programs, anti-alcohol craving medications, treatment for malnutrition, anti-inflammatory drugs, corticosteroids and other drugs. (9)
- Many drugs exist to help tame itching from bile buildup. First-line options include rifampicin, serotonin reuptake inhibitors (sertraline) and opioid receptor antagonists, which can cause withdrawal problems. (10)
- To avoid liver failure death, the last treatment to try is a liver transplant.
For acute liver failure treatment, here are some of the things that doctors may use:
- Blood tests are used to find out the type of virus that has caused hepatitis.
- If you have taken too much acetaminophen or have a viral illness that caused liver failure, you may be given care at a hospital. Sometimes your liver may recover from some of the damage.
- Acetylcysteine is used for patients with non-acetaminophen-related acute liver failure (see below).
- Patients with encephalopathy may need to be sedated and may need a breathing tube (intubation) to control their airways.
- Antibiotics may also be given to patients whose disease seems likely to progress. (6)
- To avoid liver failure death, a liver transplant may be needed.
- Medical experts may choose from several treatments to treat the particular cause and symptoms of the liver failure. For example, with mushroom poisoning doctors may try charcoal, a tube from the liver to the nose, penicillin or herbal treatments. (8)
5 Natural Tips for Managing Liver Failure Symptoms
Consider trying these tips so that you can better manage your symptoms:
Take care of your skin
- Ask about bile salts. Many doctors use natural products like bile salt resins, such as cholestyramine to stop itching. There may be side effects like diarrhea or vomiting for some patients. (11)
- Apply moisturizing ointments. Several ointments and lotions may help to calm the skin and take away the sensation of itchiness. (12) You can also try making your own Homemade Body Butter Lotion to soothe your skin.
- Try cooling ointments. Ointments that help the skin to feel cooler may help. (12)
- Cut your fingernails — Shorter fingernails will help ensure that you don’t cause damage to your skin if you try to scratch an itch. Keeping your fingernails clean and free from dirt or germs will also help your skin should you scratch or touch areas that are itchy. (12)
- Use ice cubes. Rub skin briefly with an ice cube or use a cold pack on itchy areas to take away itchiness.
- Try colloidal (finely ground) oatmeal. Fine oatmeal sprinkled in a bath may help your itching. (13)
- Ask about light therapy. Experimental therapies such as UVA/B light can be reserved for chronic liver disease cases that don’t respond to other medical therapies. (14)
Pump up your appetite if you’re not hungry
Many people with liver failure do not feel like eating, and over time they become malnourished. Here are some tips for improving your appetite:
- Snack. Snack between meals to take in more calories. A snack at bedtime will help to tide you over through the night. Some suggested snacks for cirrhosis and advanced liver disease are:
- Milky drinks, milkshakes
- Drink water even when you don’t feel like it. Even if you feel full of fluids (common in cirrhosis), you need to work to keep your fluids in balance. Drink enough fluids so you don’t dehydrate.
- Reduce salt. Reducing salt in the foods you eat will help you continue to take in the fluids you need. Ways to get less salt include: (15)
- Eat fresh foods or foods you cook yourself
- Buy foods labeled as low salt, low sodium or no salt added. Read the nutritional labels. If there is more than 1.5 grams of salt per 100 grams then it is high in salt.
- Take the salt shaker off the table.
- Don’t eat cured meats, such as bacon and sausage.
- Use alternative spices rather than salt:
- Ground pepper
- Lemon juice fruit jellies with lamb or pork
- Olive oil and vinegar with salads and greens
- Onions, scallions, shallots, leaks
- Toasted or ground sesame seeds
- Fresh garden herbs, lime, garlic, chili and ginger
Try a liver disease diet
- Eat less protein. People with liver damage may not be able to process food proteins as well as they used to. Waste products can build up and eventually affect the brain and thinking. Have about 1 gram of protein each day per kilogram of body weight. A 154-pound man weighs 70 kilograms. He should have only about 70 grams of protein each day. That does not include other foods.
- Increase healthy carbohydrates you eat. Carbohydrates should be the source of most calories in the diet.
- Eat lots of fruits and vegetables, and high fiber plant-based food.
- Eat moderate amounts of fat. Together with carbohydrates (in increased number), fats can help to prevent protein breakdown in the liver.
- Cut out alcohol
- Limit salt
- Take vitamins and minerals suggested by your health care providers. B vitamins are especially good for some people with liver damage. Supplements may be needed for nerve problems, low blood counts or nutritional problems.
- Light therapy may be useful. Bright light in the morning may work as a way to fight daytime sleepiness. Case reports have shown that this technique works in some people to improve wakefulness. (18)
- Get checked for sleep apnea, which could affect your night’s sleep. Early detection of sleep apnea now has a role in managing liver cirrhosis.
- Get checked for restless leg syndrome, which is common among people with livers that aren’t functioning well. (19) There are some natural alternatives to drugs for restless legs as well: (20)
- Light therapy
- Exercise training
- Do what you can to reduce itching at bedtime
- Try late snacking at least one to two hours after the dinner meal and one to two hours before you lie down. This may decrease a risk of acid reflux at night, if that is a problem. (21)
Consider certain herbal supplements for liver health and detoxification
Certain herbal remedies have been found to be helpful for people with a liver that is failing. Liver detoxification, also called a liver cleanse, is part of treatment for other liver conditions, besides liver failure. If your doctor gives you the OK, consider trying some of these supplements that may aid your liver: (22)
- Stronger neominophagen C (SNMC). SNMC is a compound that contains natural ingredients glycyrrhizin (from licorice root), cysteine (amino acid) and glycine (amino acid). SNMC is mainly an anti-inflammatory drug, which means it reduces inflammation, a natural process that can make the affected part of your body swell or feel warm and painful.
- SNMC has been shown to improve the rate of death in patients with subacute (not yet acute) liver failure. It also improves liver function in patients with subacute liver failure, chronic hepatitis and cirrhosis. SNMC does not reduce mortality among patients with cirrhosis, however. (23)
- Milk thistle seed. Milk thistle seed may also be helpful in detoxifying your body. It may help to cleanse the liver and eliminate toxins (poisons). (24)
- Milk thistle can be taken by mouth as a pill or as a detox tea. Silymarin (an extract of milk weed thistle) is approved in Europe for liver damage, especially damage related to drinking alcohol. (23)
- Six family members were poisoned by Amanita phalloides (death cap) mushrooms in 2007 and were treated with milk thistle for liver failure risk, with approval from the U.S. Food and Drug Administration. Only one died and the others made a full recovery. (25) Twenty years of data on poisoning by Amanita, Galerina and Lepiota mushrooms showed that milk thistle extract given alone or in a mixture was among the most effective therapies for mushroom poisoning. (26)
- A study of milk thistle for chronic liver disease showed that it appears safe and well tolerated by patients. (27)
- N-Acetylcysteine (NAC). NAC use is linked with a reduction in death rate from acute liver failure and was safe to use in cases where patients weren’t poisoned by an overdose of acetaminophen. (28)
- See a doctor if you suspect either form of liver failure, especially acute, when symptoms come on fast.
- If you notice that you, a friend or a family member has yellowing eyes or skin, complains of a tender upper right abdomen or has an unusual change in their mental state, go to a doctor. If the symptoms come on suddenly, this may mean acute liver failure is occurring. (2)
- Always talk with a health care professional before starting any herbs or supplements. Some natural remedies can interact with medications or make certain health problems worse.
- Don’t drink alcohol in excess. If you have a problem with alcohol use, please seek help to stop.
- Don’t eat wild mushrooms or other potentially poisonous wild foods unless you know them. Learn to recognize poisonous mushrooms.
Liver Failure Key Points
- Liver failure occurs when the liver stops working the way it should and can’t catch up. This can cause toxins to build up in the body. It can be deadly if not treated.
- If liver failure symptoms come on quickly, get to a hospital or doctor right away.
- Know that there are many different reasons why you might have liver failure. Be aware of what may cause it.
- Hepatitis infections and alcoholism are major factors in liver failure. Fatty liver may also lead to liver failure. Get tested if you think you might be at risk.
- Some drugs, herbs, and poisonous mushrooms can bring on acute liver failure.
5 Natural Tips for Managing Liver Failure Symptoms
- Take care of your skin
- Pump up your appetite
- Try a liver disease diet
- Treat sleepiness
- Consider certain herbal supplements for liver health and detoxification