Fulminant hepatic failure

Fulminant hepatic failure is an uncommon but dramatic illness with a high mortality. Viral hepatitis or drug toxicity is the usual cause. In the severe forms of the illness the patients, often young and previously healthy, rapidly become profoundly unwell due to extensive hepatic necrosis. Coma is accompanied by a disastrous disturbance of all the synthetic, metabolic and excretory functions of the liver. Management is largely supportive and multisystem complications may demand all the resources of the intensive care unit to allow survival. Systems for temporary hepatic support have aroused interest, based on the assumption that the hepatic lesion is potentially reversible. A number of heroic techniques have been tried and abandoned. Encouraging reports of charcoal column haemoperfusion have yet to be confirmed by controlled clinical trial.