SN instructed patient on liver failure. The early symptoms of liver failure are similar to symptoms of many other conditions. Because of this, liver failure may initially difficult to diagnose. Some of the most common initial symptoms of liver failure are: Nausea, Loss of appetite, fatigue, diarrhea. As liver failure progresses, the symptoms become more serious. The most common symptoms of advanced liver failure include: Skin itchiness, jaundice, bleeding easily, bruising easily, swollen abdomen, mental disorientation or confusion, sweet or foul smelling breath, sleepiness, coma. Educated patient that the liver filters the Ammonia out the blood and that liver failure causes Ammonia levels to increase, which cause change of mental status, confusion, and sleepiness or fatigue.