Acute liver failure: symptoms, causes, paracetamol overdose and treatment

Liver UK lists the symptoms of acute liver failure caused by a paracetamol overdose, and stresses that if you think you have taken too much you should get help straight away rather than wait for symptoms. The NHS says that jaundice, a yellow colour in the skin or the whites of the eyes, can be a sign of something serious such as liver disease, so you need to get urgent medical help; yellowing may be less noticeable on brown or black skin, but the white part of the eyes will look yellow. Itchy skin, darker pee and paler poo than usual can also occur.

• A yellow colour in the eyes or skin (jaundice).

• Low blood sugar, sweating and trembling.

• Being irritable, or more clumsy or less coordinated than usual.

• Feeling sick or being sick.

• Feeling very tired.

• Pain in the tummy.

Liver UK says always go to hospital straight away if you think you might have taken too much paracetamol. The NHS says taking an extra dose is unlikely to cause problems, but it is important to get medical advice if you take too much as it can sometimes damage your liver; get help from NHS 111 if you have taken more paracetamol than it says on the packet or leaflet. If you are told to go to A&E, do not drive: ask someone to drive you or call 999 and ask for an ambulance. Bring the paracetamol packet or leaflet, any remaining medicine and any other medicines you take.

For yellow skin or eyes, the NHS says to ask for an urgent GP appointment or get help from NHS 111. If you are feeling very unwell, confused or drowsy, call 999. The sources reviewed do not list further emergency signs.

Liver UK describes acute liver failure as a very serious condition that happens suddenly, with lots of causes, and says that with medical help most people will be able to recover. It is different from long-term liver disease. The NHS describes common types of long-term liver disease, such as alcohol-related liver disease, non-alcoholic fatty liver disease, hepatitis and haemochromatosis, which most often do not cause symptoms in the early stages, whereas acute liver failure starts suddenly.

Liver UK says other medicines can sometimes damage your liver. When this happens it is called drug-induced liver injury (DILI).

Liver UK says that in the UK the most common cause in adults is an overdose of paracetamol. Most cases are caused by a deliberate overdose, but it can also happen by accident, because many medicines contain paracetamol, including a lot of cold and flu medicines that you can buy from a pharmacy. You can accidentally take too much paracetamol if you mix different medicines. Always read the label and check whether a product contains paracetamol; if you are not sure, ask the pharmacist.

The NHS paracetamol advice says not to take paracetamol at the same time as other medicines containing paracetamol, for example cold and flu remedies, because you may take too much, and not to take it for more than 3 days unless a doctor tells you to. The sources reviewed do not set out the other, rarer causes of acute liver failure in detail, so a liver specialist can explain what applies in your case.

To help doctors decide on the best treatment after a paracetamol overdose, Liver UK says you should tell them how much paracetamol you have taken, when you took it, and any other medicines you have taken, including prescription medicines, pharmacy medicines, recreational drugs, supplements and herbal or alternative medicines. If you can, take the packets of everything you have taken, or photos of the labels.

Liver UK says doctors might also do a blood test to see how your liver is doing and how much paracetamol is in your blood.

For a paracetamol overdose, Liver UK says that if you need treatment you will be given a drug called acetylcysteine (you might hear the name Parvolex) as a drip, which takes about 24 hours to give the full dose. You might also be given activated charcoal, which can help stop paracetamol getting into your blood and other parts of your body. The sooner treatment starts, the less chance of any lasting damage to the liver.

If you are already very poorly when you get help, Liver UK says you might need more intense treatments because liver failure can affect your whole body, so you might need an intensive care unit. While in hospital you might be asked to speak to a member of the mental health team, in some places even if the overdose was accidental, as a routine check. NHS Blood and Transplant describes liver transplant as a treatment for some patients with cirrhosis and end-stage liver disease; the sources reviewed do not describe transplant for acute liver failure, so ask your liver team if it is relevant.

Liver UK says most people will make a full recovery from acute liver failure caused by a paracetamol overdose. It adds that your liver has an amazing ability to repair itself, but this can take time, and you might feel very tired for a few weeks or months, which is normal but can make it hard to do usual activities for a while.

It can still be worrying to know your liver was so poorly. If you are struggling with your mental health, Liver UK points to Samaritans, free and open all day every day.

The sources reviewed do not give specific advice about acute liver failure in pregnancy. If you are pregnant and have taken too much paracetamol, or have jaundice, get urgent advice from NHS 111 or your midwife. The NHS says that if you are pregnant, a pharmacist can advise about which medicines you can take.

To prevent paracetamol-related liver damage, follow the dose on the packet, avoid combining products that contain paracetamol, and ask a pharmacist if unsure. If you already have a liver condition, Liver UK says to talk to your doctor about which pain medicines are best for you and how much you can take. The NHS advises staying within recommended alcohol limits to prevent some types of liver disease.

Acute liver failure is an emergency managed through NHS 111, 999 and hospital emergency departments, with intensive care and liver specialist input if needed. NHS Blood and Transplant notes there are 7 liver transplant centres in the UK. Private care is not an alternative for an emergency, though a private hepatologist can help with follow-up of liver blood tests afterwards.