Jeremiah Raber, best known for his reality show “Breaking Amish”, was reportedly recently airlifted to hospital with “possible liver failure,” and it brought attention to his unexpected life-threatening medical emergency.Taking to social media, the TV personality posted a selfie from the hospital bed, and wrote, “Sugar levels 993, possible liver failure, waiting to be life flighed to another hospital” (sic). In medical terminology, because his blood sugar levels reached 993 mg/dL, he probably developed severe diabetic ketoacidosis (DKA), and his liver function started to deteriorate. This occurs because the body faces extreme stress which causes the liver to fail quickly because of metabolic breakdown, dehydration, infection and drug poisoning that requires immediate medical assessment in an intensive care setting.What “possible liver failure” meansThe clinical warning “Possible liver failure” indicates that the liver function is deteriorating rapidly, which indicates acute liver failure also known as fulminant hepatic failure. This means the liver loses its ability to detoxify the blood, make proteins, and support metabolism over a short time-usually days to weeks-in someone who may not have had obvious liver disease before. The situation requires ICU treatment, because medical staff must treat it as an emergency because death will result from untreated complications which include brain swelling, bleeding and kidney failure.
How diabetes and DKA can harm the liverJeremiah has brittle type 1 diabetes, because his blood sugar levels become extremely difficult to manage, and he experiences dangerous fluctuations between high and low levels. The body develops diabetic ketoacidosis (DKA), when blood sugar levels become excessively high at 993 mg/dL, because it fails to convert glucose into energy so it starts fat breakdown which results in dangerous ketone production. The body experiences multiple organ stress due to DKA, which leads to acute kidney injury and liver dysfunction.
The development of diabetes creates a higher chance for patients to develop fatty liver disease, which medical professionals now call metabolic dysfunction–associated steatotic liver disease (MASLD). The disease MASLD starts as silent liver fat accumulation, which can eventually develop into liver inflammation and scarring. Research indicates that diabetes patients face an elevated danger of developing severe acute liver injury, which leads to poor medical results during their hospital stay for liver complications. The risk of acute liver failure becomes higher for brittle diabetes ,patients when their blood sugar levels become extremely high or when they experience dehydration, or develop infections or take specific medications.Common causes of acute liver failureDoctors look for several possible causes when someone presents with “possible liver failure”:Acetaminophen (paracetamol) overdose – The most common cause of acute liver failure in many countries; even slightly more than the recommended dose over a few days can poison the liver.Viral hepatitis – Hepatitis A, B, and E can cause sudden, severe liver damage.The liver becomes infected by three viral pathogens which include Epstein-Barr (EBV) and cytomegalovirus (CMV) and herpes simplex.Medicines and supplements-The following prescription medications and herbal products have been proven to cause liver damage: antibiotics, anti-seizure medications, NSAIDs, kava, ephedra and skullcap and pennyroyal.The liver cells experience destruction when Amanita species mushrooms or industrial substances enter the human body.Autoimmune hepatitis-The immune system attacks the liver which results in quick liver inflammation that leads to organ failure.Vascular problems – Blockage of liver veins (Budd-Chiari) can cut off blood flow and damage the liver.Metabolic diseases – Wilson’s disease (copper overload) and acute fatty liver of pregnancy represent two rare medical conditions which lead to unexpected liver failure.Cancer and severe infection-Liver tumors or overwhelming infection (sepsis) can also lead to acute liver failure.In some cases, no clear cause is found, and doctors label it “indeterminate” acute liver failure.Warning signs of liver failureThe first signs of liver failure present as nonspecific symptoms which resemble flu symptoms.Yellow skin and eyes (jaundice).The upper right section of the belly produces discomfort which extends to pain.Swollen belly (ascites) from fluid buildup.The condition produces two main symptoms which are nausea and vomiting, that result in patients developing no interest in food.Extreme tiredness and weakness.The development of severe symptoms occurs during the progression of liver failure.The condition known as hepatic encephalopathy causes patients to experience confusion, together with disorientation and difficulties in their thinking processes.Sleepiness or coma.The body shows two main signs which include tremors and flapping hand movements known as asterixis.The breath of a person contains two possible scents which are either pleasant, or have a strong unpleasant odor known as fetor hepaticus.The body fails to form proper blood clots which results in easy bruising and uncontrolled bleeding.The legs together with the abdomen, display symptoms of swelling.People who develop sudden jaundice together with belly pain or confusion, need to receive immediate hospital treatment.How doctors investigate and treat itDoctors perform blood tests which include liver enzyme, bilirubin, INR and albumin evaluations, to check for viral and toxic substances, while they use ultrasound, CT and MRI imaging, to visualize the liver and blood circulation. The medical team searches for brain swelling, kidney damage and infection as potential complications.The required treatment for this condition depends on what caused the condition to develop.Supportive ICU care-The medical team performs continuous brain function tests while they monitor blood pressure and conduct tests to evaluate kidney function, and clotting system activity.Medical staff need to give N‑acetylcysteine (NAC), as an antidote to patients who have taken acetaminophen overdose.The treatment approach focuses on addressing the underlying condition through antiviral therapy for hepatitis, drug cessation, infection management and autoimmune disease control.The treatment of complications requires medical staff to administer medications which reduce brain swelling and blood products for bleeding management, dialysis for kidney failure treatment and antibiotic therapy for infection control.Liver transplant-The last resort for patients with severe liver damage becomes liver transplant when their liver fails to heal.Outlook and preventionThe success rate of treatment depends on two factors which include the original cause of the condition, and the timing of medical intervention. Medical intervention at the first sign of acetaminophen overdose and viral hepatitis, will enhance the chances of patient recovery. The treatment of indeterminate causes, autoimmune or metabolic diseases needs organ transplantation, yet patients who receive early treatment for acetaminophen overdose and viral hepatitis, will achieve improved results.People who have diabetes and other chronic diseases need to defend their liver, because this organ performs vital functions which support their health.Follow all medical instructions regarding your prescribed medications, and stay away from using acetaminophen painkillers unless your doctor approves it.People need to avoid drinking alcohol, because alcohol consumption becomes hazardous when liver damage appears.Get vaccinated against hepatitis A and B, if at risk.People who want to prevent fatty liver disease should keep their weight in check, while managing their blood sugar levels, blood pressure and cholesterol numbers.Avoid wild mushrooms and be cautious with herbal supplements and chemicals.Medical check-ups which include liver function tests and HbA1c measurements and kidney function assessments help doctors identify health issues at their initial stages.Disclaimer: This article is informational only and not a substitute for medical advice
