Fulminant hepatic failure is a rapidly progressive and often fatal syndrome, and the only definitive treatment is liver transplantation. However, given the scarcity of available grafts, the mainstay of therapy remains supportive care until there is spontaneous recovery or until a suitable donor liver becomes available. After initial assessment and stabilization, patients should be transferred to the nearest liver transplant center as soon as possible, as they can deteriorate rapidly. All patients with fulminant hepatic failure must be monitored closely and treated for hepatic encephalopathy, coagulopathy, gastrointestinal bleeding, renal failure, cerebral edema, and metabolic derangement.