When Does Transaminitis Become Acute Hepatic Failure? What Is the Management of Transaminitis and Acute Hepatic Failure?

  • Michelle A. HiegerEmail author


The non-toxicological causes for elevated transaminases include infection, ischemia, metabolic derangements, malignancy, autoimmune disease, and primary graft failure after transplant. Acute liver failure is a common pathway for many conditions and insults, leading to massive hepatic necrosis or loss of normal hepatic function. Acute liver failure can be described in different subgroups by acuity of encephalopathy onset. Tools exist to aid in the prognostication of acute liver failure. Treatment of transaminitis and disposition of the patient are guided by the underlying diagnosis.


Transaminases Liver function tests LFTs Drug toxicity Hepatitis 


  1. 1.
    Dalhoff K. Toxicant-induced hepatic failure. In: Brent J, et al., editors. Critical care toxicology. Cham: Springer International Publishing; 2016. p. 385–408.Google Scholar
  2. 2.
    Moore P, Burkhart K. Adverse drug reactions in the ICU. In: Brent J, et al., editors. Critical care toxicology. Cham: Springer International Publishing; 2016. p. 693–741.Google Scholar
  3. 3.
    Aghababian RV. Essentials of emergency medicine. Hepatitis. Sudbury: Jones & Bartlett Learning; 2010.Google Scholar
  4. 4.
    O’Grady JG, et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989;97(2):439–45.CrossRefGoogle Scholar
  5. 5.
    O'Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. 1993;342(8866):273–5.CrossRefGoogle Scholar
  6. 6.
    Murali AR, Narayanan Menon KV (2017) Acute liver failure [cited 4 Mar 2018]; Available from:
  7. 7.
    O’Grady JG, Williams R. Management of acute liver failure. Schweiz Med Wochenschr. 1986;116(17):541–4.PubMedGoogle Scholar
  8. 8.
    Susan R, O’Mara KG. Hepatic disorders. In: Tintinalli JE, et al., editors. Tintinalli’s emergency medicine: a comprehensive study guide. New York: McGraw-Hill Education. p. 525–33.Google Scholar
  9. 9.
    Delaney KA. Hepatic principles. In: Hoffman RS, editor. Goldfrank’s toxicologic emergencies. New York: McGraw-Hill Education. p. 302–11.Google Scholar
  10. 10.
    McPhail MJ, Wendon JA, Bernal W. Meta-analysis of performance of Kings’s college hospital criteria in prediction of outcome in non-paracetamol-induced acute liver failure. J Hepatol. 2010;53(3):492–9.CrossRefGoogle Scholar
  11. 11.
    Fikatas P, et al. APACHE III score is superior to King's college hospital criteria, MELD score and APACHE II score to predict outcomes after liver transplantation for acute liver failure. Transplant Proc. 2013;45(6):2295–301.CrossRefGoogle Scholar
  12. 12.
    Shami VM, et al. Recombinant activated factor VII for coagulopathy in fulminant hepatic failure compared with conventional therapy. Liver Transpl. 2003;9(2):138–43.CrossRefGoogle Scholar
  13. 13.
    Muñoz SJ. Difficult management problems in fulminant hepatic failure. In:Seminars in liver disease. New York: Thieme Medical Publishers; 1993.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Section of Toxicology, Department of Emergency MedicineWellSpan Health, York HospitalYorkUSA

Personalised recommendations