Although acute liver failure (ALF) is a rare clinical presentation in the ED, it carries a high mortality, morbidity, and resource cost.

Across the developing world, the underlying etiology is primarily viral, with hepatitis B and E infections recognized as leading causes in many countries.

Conversely, in the USA and much of Europe, the incidence of virally associated liver failure has declined substantially, with most cases now arising from drug-induced liver injury, frequently from acetaminophen or idiosyncratic drug reactions.

While data from developing countries is sparse, surveillance reports from the developed world suggest an overall incidence between one and six cases per million people every year, or around a total of 2,000 cases per year.

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