Acute liver failure is a complex multi system disorder that results from an acute severe insult to the liver in a previously well child. It has an unpredictable course and high mortality in children. Encephalopathy and uncorrectable coagulopathy are essential pre requisites in diagnosis. Metabolic diseases are the commonest cause in infants. Viral hepatitis predominates in older children. A large percentage of children have no identifiable cause.  Management of a child with ALF includes basic intensive care to ensure regulation of fluid status, glucose and electrolyte homeostasis and specific measures to reduce serum ammonia concentration, as well as the prevention and prompt treatment of complications. Important complications that require urgent recognition and management include coagulopathy, cerebral edema, sepsis and renal dysfunction. Cerebral edema is the most important reason for death in acute liver failure. Increasing jaundice, uncorrected prothrombin time and rapidly falling ALT values in a clinically deteriorating patient indicates poor prognosis. Management is aimed at life support and prevention of complications, while facilitating regeneration of the liver. Liver transplantation is the only definitive treatment that improves outcome.

Key words: encephalopathy, coagulopathy, cerebral edema, liver transplantation.