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It happens when reduced blood flow to the liver causes liver cells to die. It is most common among people who have other serious medical conditions. Cardiac shock, respiratory failure, and septic shock are the main causes of shock liver. Most people who develop this condition are already very ill. Shock liver can be fatal for about half of the people with the condition, but others recover. The management of the underlying disease that led to shock liver is a key predictor of whether a person survives. People use many names to refer to shock liver, including ischemic hepatitis and hypoxic hepatitis. Shock liver means that blood flow to the liver slows or becomes blocked. Read on to learn more about shock liver, including its causes, symptoms, treatment, and outlook. Causes Share on PinterestCRISTINA PEDRAZZINI/SCIENCE PHOTO LIBRARY/Getty ImagesShock liver can be a sign of a serious underlying illness — often heart disease or heart failure. About 25% of the heart’s blood flow goes to the liver. Therefore, when the heart is working poorly, the liver is also in danger. This can limit blood flow to the liver, causing shock liver. Other conditions that may increase the risk include: very low blood pressuresepsis from a serious infection sickle cell crisis in a person with sickle cell diseasedamage to liver blood vessels during a liver transplant Occasionally, shock liver may develop suddenly due to another acute illness, such as poisoning from medication or carbon monoxide. People who develop shock liver are often already very ill and may be in the intensive care unit (ICU). It is a common cause of liver dysfunction in ICUs, accounting for about 2.5% of ICU admissions. Most people who develop shock liver have heart disease and a heart health event, such as heart surgery or a heart attack, that can precede the liver shock. According to a 2021 review reporting on prior research, one study showed that 78.2% of participants with shock liver had a cardiac event prior to their diagnosis, with 23.4% experiencing sepsis and 52.9% having an episode of very low blood pressure. Symptoms The symptoms of liver shock are similar to those of other liver diseases and may include: tenderness in the abdomen nauseavomitingjaundice, which may turn the skin yellow or the urine dark Other conditions Some other conditions can cause similar liver symptoms. Comprehensive testing, including daily monitoring of bloodwork, can help distinguish shock liver from these conditions: acute viral hepatitis, or a worsening of chronic hepatitis autoimmune hepatitisliver injuryliver traumagallstone obstruction toxic hepatitis from medication or drugs heart disease and heart failure Diagnosis A doctor may suspect shock liver in someone with sudden symptoms of liver disease, especially if they have serious underlying illnesses. A doctor may order additional tests, such as a liver ultrasound, to rule out other potential causes of a person’s symptoms. They may also use imaging tests, such as an MRI, to identify blockages in the liver and their potential causes. Criteria for diagnosis A diagnosis of shock liver requires: A doctor to suspect that a person has cardiac, circulatory, or respiratory failure.Tests that show an abrupt increase in serum aminotransferase, though this may be short-lived.Exclusion of other causes of liver cell damage — for example, viral hepatitis or drug-induced hepatitis. Blood tests Diagnosing this condition begins with bloodwork to check for signs of liver injury. A doctor will likely repeat bloodwork over several days. In most people, symptoms begin with sudden elevations in plasma aminotransferase and lactate dehydrogenase in their bloodwork. These are enzymes found in the body. People also usually have cardiac symptoms. Liver enzyme levels can also rise in the following order: AST (aspartate aminotransferase), then ALT (alanine transaminase). AST levels usually remain higher than ALT. In about 50% of cases, shock liver can cause a sudden and dramatic increase in AST. Doctors may also look at prothrombin time (PT), a test to measure the time it takes for blood to clot. Learn more about liver tests and what they mean here. Treatment Treatment focuses on addressing the underlying cause of liver shock. The goal is to restore blood flow to the liver. Doctors call this hepatic reperfusion. For example, a 2020 paper details the case of a 21-year-old who developed shock liver following cardiogenic shock. Surgery to replace the mitral valve restored their liver function. When heart failure can cause liver shock, doctors may recommend drugs such as diuretics or vasoconstrictors to restore blood flow. When septic shock is the cause of liver shock, a doctor may prescribe antibiotics — usually intravenously through a vein. Some evidence suggests that the drug dopamine may improve blood flow to the liver. Doctors can also prioritize managing symptoms through oxygen therapy and ongoing monitoring in the hospital. Shock liver is usually a complication of another illness, such as systemic infection or heart failure. No specific prevention strategy can prevent shock liver. However, preventing other illnesses may reduce the risk of shock liver. Outlook Shock liver is a very dangerous condition with a high death rate of 40–80%. In most cases, death is not a result of liver failure but shock liver can be a sign that the underlying disease is progressing. In this regard, shock liver is a sign of a poorer outlook for the disease that caused it. Certain factors increase the risk of death, which can include: advanced agea high risk score associated with the underlying condition that led to shock liverpersistently elevated aminotransferase and LDH levelsthe international normalized ratio (INR) level is higher than 2. This is a type of calculation based on PT results.bilirubin level higher than 3 milligrams per deciliter, along with worsening jaundiceusing vasopressorsacute kidney injury Prompt diagnosis of this condition can help improve a person’s outlook. Liver failure The main risk of shock liver is liver failure. Decreased blood flow to the liver damages the cells of the liver. With enough damage, the liver loses the ability to function. Without treatment, liver failure can be fatal. A person might need a liver transplant if the damage to the liver is severe enough. Learn more about liver failure here. When to consult a doctor People with shock liver are often already severely ill. Anyone who experiences signs of shock liver or of another serious illness should consult a doctor for urgent medical attention. Some symptoms to be aware of include: jaundice, such as yellow skin or eyes, or very dark urinefeeling very sickupper abdominal pain and tendernesschest painsudden high feversymptoms of sepsis, such as low blood pressure and feeling very ill Summary Shock liver, or ischemic hepatitis, is a serious and life threatening condition. It is often a sign that an underlying medical condition, such as heart failure, is worsening. Treating shock liver requires managing the underlying condition and preventing liver failure. A person with shock liver may need to stay in the hospital for monitoring and will likely need ongoing treatment. People who think they have liver health issues should treat their symptoms as an emergency, especially if they have an underlying health condition such as heart failure or heart disease. 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