CASE 03•8–10 minutes•Acute liver failure · Acute hepatitis · Transplant referral · Encephalopathy

Severe acute hepatitis: when do you call the transplant centre?

A previously well patient develops severe acute hepatitis, coagulopathy and then encephalopathy. Decide when this becomes acute liver failure and when transplant-centre involvement should begin.

For clinicians working in critical care, hepatology, gastroenterology and acute medicine.

Distinguish severe acute liver injury from acute liver failure.

Refer early rather than waiting for formal emergency transplant criteria to be fulfilled.

Recognise the evolving risks of encephalopathy, cerebral oedema, hypoglycaemia, renal failure and multiorgan dysfunction.

Day 1 · Acute medical unit

The hepatitis

Stage 1 of 5

Severe liver injury — but is this acute liver failure?

A 32-year-old woman with no known chronic liver disease presents with jaundice, nausea and malaise. She is alert and orientated. Viral, autoimmune, drug-related and metabolic investigations are underway. There is no history of paracetamol overdose, but timing and exposure remain uncertain.

ALT5,800 IU/L

Bilirubin146 µmol/L

INR2.1

Creatinine82 µmol/L

Glucose4.6 mmol/L

Mental stateNormal

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Educational content only. The case is fictional and does not replace local guidance, specialist advice or individual clinical judgement.

Clinical review: Dr Tom Dixon · 2026-09-28

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