This presentation provides a comprehensive, case-based exploration of acute liver failure (ALF), its pathophysiology, and the evolving landscape of critical care management. Using two contrasting real-patient scenarios—mushroom-induced amatoxin poisoning and severe acetaminophen toxicity—the session illustrates early recognition, diagnostic interpretation, and evidence-based interventions across the continuum of ALF care. Participants will review hepatic function, splanchnic circulation, ammonia metabolism, and the mechanisms driving encephalopathy and multiorgan failure. Emphasis is placed on timely treatment strategies, including antidotes such as N-acetylcysteine, penicillin G, and silibinin, alongside supportive measures aimed at preventing intracranial hypertension.

The session also highlights advanced therapeutics, including extracorporeal liver support (ECLS) systems and emerging bioartificial technologies such as the miroliverELAP® external liver assist device. Learners will examine transplant considerations, King’s College criteria, and the expanding role of living, brain-death, and circulatory-death donors. By integrating physiology, clinical reasoning, and cutting-edge interventions, this presentation equips clinicians with the knowledge needed to manage complex ALF presentations and support patients through high-risk, rapidly evolving clinical trajectories.