Acute liver failure is a serious medical emergency resulting from various insults that liver sustains. In our setting, viral etiology is the commonest cause. The syndrome results in significant liver damage leading to hepatic encephalopathy, coagulopathy and several other serious clinical consequences. Sepsis, cardio vascular failure and renal failure can result in multi system organ failure and fatal consequences. Management requires identification of etiologic agent as soon as possible. Nursing care in intensive care unit (ICU) setting is re commended. Attention towards correction of electrolyte imbalance, coagulopathy, encephalopathy and systemic complication along with judicious use of antibiotics help in obtaining a favorable outcome. Transplant remains the ultimate management.