Acute liver failure is a severe emergency condition secondary to a myriad of causes associated with poor outcomes. The prompt diagnosis and identification of the aetiology allow the administration of specific treatments plus supportive strategies and to define the overall prognosis, the probability of developing complications and the need for liver transplantation. Main issues are adequate monitoring and the institution of prophylactic strategies to reduce the risk of complications, such as progressive liver failure, cerebral oedema, renal failure, coagulopathies or infections.Also the patient needs to be transferred to a higher centre for liver transplant if need arises .Here, we review the main aspects of acute liver failure including the definition, diagnosis and complications. Also, we describe the standard-of-care strategies and recent advances in the treatment of acute liver failure.