What Is Fulminant Hepatitis?

By Teresa Dumain
 Medically Reviewed by Carmelita Swiner, MD on February 07, 2020

Fulminant hepatitis is when your liver begins to fail very

quickly within days or weeks, depending on the cause. This sudden liver
failure can happen in people who previously had stable liver disease or
never had liver problems.

You might also hear it called “fulminant hepatic failure” or “acute liver
failure.” It can quickly become life-threatening. Get medical attention
right away if you or someone close to you shows any signs.

Causes

Your liver can fail if its cells get damaged and stop working. Fulminant
hepatitis is most often caused by:

An overdose of acetaminophen. This painkiller is found in many over-

the-counter and prescription medicines. Taking one very large dose can
cause your liver to fail quickly. The same may happen if you take more
than the recommended amount for several days in a row.

If you or someone you know has taken too much acetaminophen, call
911 right away.
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Viral hepatitis. Infection from certain viruses, including hepatitis A, B, C,
D, or E, may lead to sudden liver failure.

Some less common causes of fulminant hepatitis include:

Prescription medicines. Some antibiotics , cancer medicines,

and other drugs can cause liver damage that leads to liver failure.

Certain viruses. Epstein-Barr virus, for example, or herpes simplex

virus may cause fulminant hepatitis.
Autoimmune hepatitis. This happens when your immune
system attacks and damages liver cells.
Cancer . Tumors that start or spread to the liver can cause it to
fail.
Vein problems. One disease of the veins in the liver, called Budd-
Chiari syndrome, causes blockages that can lead to liver failure.
Mushroom poisoning. The wild mushroom Amanita phalloides
may seem safe to eat. But it has very strong toxins that damage the
liver.

Wilson’s disease. This disorder allows copper to build up in your

liver and other organs. Too much copper can be dangerous.
Some herbal products such as kava, ma huang (ephedra), and
comfrey may lead to liver failure.

In many cases, doctors can’t find the cause of fulminant hepatitis.

Symptoms

At first, these may include:

:
 Not feeling well

Tiredness
Nausea
Stomach discomfort or pain

If it gets worse, symptoms include:

Yellowing of your skin or eyeballs (jaundice)

Feeling very confused
Sleepiness

Changes in your personality or behavior, such as being more

irritable or disoriented
Bleeding or bruising more easily
Stomach swelling

Diagnosis

Your doctor will ask about your medical history, any past drug use, and
if you’ve been exposed to toxins. They will also check for symptoms of
hepatitis and test how mentally alert you are.

To help diagnose and find the cause of fulminant hepatitis, your doctor
may ask for:

Blood and urine tests. Results can show how well your liver
works. Your doctor will also do a test to see how long it takes for
your blood to clot. When you have fulminant hepatitis, blood
doesn’t clot as fast as it should.
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 Scans of your liver. Imaging tests allow your doctor to check the
liver for damage, vein problems, tumors, or other issues. You may
get an ultrasound, MRI, or CT scan.

A liver biopsy. Your doctor will remove a small piece of your liver
tissue to check.

Treatment

You will likely go into a hospital’s intensive care unit. Treatment for
sudden liver failure depends on the cause. It may include any of the
following.

Antidotes. This is a type of medicine used to counteract the effect of

poison. If your liver suddenly starts to fail from an overdose of
acetaminophen, your doctor may give you an antidote called N-
acetylcysteine to stop the effects. This medicine may also help treat
other causes of acute liver failure.

Other antidotes can help reverse the effects of mushroom poisoning

and help reduce liver damage.

Medicines to treat hepatitis. Doctors use antiviral medicines to treat

some forms of viral hepatitis. For example, if hepatitis B is the reason
your liver is failing, an antiviral drug can fight the virus. Other antivirals
may help if the herpes simplex virus is causing fulminant hepatitis.

You may get steroids if autoimmune hepatitis is the cause.

Liver transplant. If other treatments can’t get your liver to work again,
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you may need a new liver. If you get approved for a liver transplant, your
name goes on a waiting list to get a donated organ. People with the
most urgent need top the list.

During a liver transplant, a surgeon removes your damaged liver and

replaces it with a healthy one from a donor.

Scientists are researching new treatments that could reduce or delay

the need for a liver transplant.

Your doctor will also treat symptoms and side effects you have. That
care may include:

Medicines to relieve pressure on your brain. One of the most

serious side effects of acute liver failure is swelling in the brain .
Extra fluid causes pressure to build up, which can lead to brain
damage. Certain medicines can help ease the swelling.
Tests to check for infections. Fulminant hepatitis makes you more
likely to get an infection in your blood or urinary tract, for example.
Blood or urine tests can find the infection so your doctor can treat
it.

Medicines to prevent bleeding. Your liver makes chemicals that

help your blood clot. When your liver is failing, it can’t make
enough of them. As a result, the chance of severe bleeding in your
body is higher. Medicine can help prevent bleeding. If you do lose a
lot of blood, you may need a blood transfusion.

Can You Prevent It?

In some cases, you can. The two most common causes of fulminant
:
hepatitis are acetaminophen overdose and viral hepatitis. To help lower
your chances:

Take acetaminophen as directed. Check the label for the

recommended dose, and don’t take more than that.
Avoid contact with other people’s blood and body fluids. This
can lower your chance of getting infected with a hepatitis virus. If
you visit developing countries, you should avoid the local tap water
. And there are vaccines available to prevent hepatitis A and
hepatitis B, which are more common in some parts of the world.
You can check the CDC’s website for traveler’s health to find out
what vaccinations and other precautions you need to take in
different countries.

WebMD Medical Reference

Sources 
SOURCES:

Nephrology Dialysis Transplantation: “Fulminant hepatic failure: etiology and indications for liver
transplantation.”

UpToDate: “Acute liver failure in adults: Etiology, clinical manifestations, and diagnosis” and “Some drugs,
herbal products, and toxins associated with acute liver failure.”

Mayo Clinic: “Acute Liver Failure.”

University of California San Francisco Department of Surgery: “Acute Liver Failure (ALF).”

Johns Hopkins Medicine: “Acute Liver Failure.”

CDC: “Travelers’ Health.”

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