Fulminant hepatic failure (FHF) is a life-threatening condition characterized by the rapid deterioration of liver functions and hepatic encephalopathy. FHF is with the basic definition of the onset of hepatic encephalopathy within 8 weeks of the appearance of the first symptoms like jaundice, fever, nausea, and vomiting. The prothrombin time is prolonged by 4-6 seconds or more. While the etiologies of FHF are multiple and varied, viral hepatitis is the most frequent cause. Around 40-60% of patients with FHF are thought to be due to some viral infection. The prognosis is dependent on several factors, including the underlying cause of liver failure. For instance, it is well known that the spontaneous recovery rates from FHF from such etiologies as hepatitis A and acetaminophen toxicity are high, whereas those same rates for other types of viral hepatitis and idiosyncratic drug reactions are quite low. Identification of the cause of FHF is important because some causes have specific treatment interventions or antidotes. Specific therapies include N-acetylcysteine for acetaminophen overdose, and acyclovir for herpesvirus infection. Different therapeutic options such as complete exchange blood transfusion, corticosteroids, and plasma pheresis, have been tried. However, the overall prognosis for patients with FHF is quite poor, with survival rates usually reported between 10% and 30% without liver transplantation.
