Fulminant hepatic failure (FHF) is defined as acute liver failure with hepatic encephalopathy in patients with no history or stigmata of chronic liver disease. Historically, its prognosis was extremely poor. However, the emergence of orthotopic liver transplantation as a viable form of therapy for liver failure and advances in intensive care medicine have improved patient survival dramatically. Treatment of this condition revolves around supportive medical care and timely referral for orthotopic liver transplantation as necessary. Treatment needs to be individualized for each patient, because prognosis varies, depending on the etiology of the condition. The clinical manifestations of FHF and the management of this condition are discussed. Future prospects for the management of FHF are also reviewed.