Acute liver failure (ALF) is an uncommon but dramatic clinical syndrome characterized by sudden and massive liver necrosis in a patient with a previously healthy liver which leads to the development of jaundice, coagulopathy and encephalopathy, and may leed to progressive multiorgan failure and death. Viral and drug-induced hepatitis are the most common causes of ALF in adults. For some causes of acute liver failure treatment aimed at the underlying cause may prevent the need for liver transplantation and decrease mortality. The signs are evolving rapidly, and based upon the velocity of the developement are graded into hyperacute, acute, and subacute form of ALF. Many patients with ALF develop a cascade of serious complications like neurological complications, infections and hemodynamic failure. Survival rates in patients treated for AFL are greater than 60%. Approximately 40% of patients survive without a liver transplantation. Liver transplantation remains the only treatment option for patients with poor prognosis. One year survival rates of the transplanted patients are greater than 80%. However, the greatest benefits in improving results and outcome of the disease will result from public health measures, early recognition and treatment of patients with acute liver failure and prevention of complications. This review gives an overview of the problem in patients with ALF considering the etiology, pathophysiology, diagnosis, treatment and prognosis of this rare but deadly entity.