The principles of management for acute liver failure are: 1. Accurate diagnosis of the type--fulminant, late onset, acute on chronic--and establishment of likely aetiology. 2. Early detection and treatment of complications, particularly metabolic acidosis (early), renal failure, cerebral oedema and infections (late). 3. Optimization of conditions for regeneration by maintenance of normal metabolic milieu (? removal of toxins). 4. Early consideration of an orthotopic liver transplant for poor prognosis group.