Patients on the waitlist for liver transplantation (LT) can develop acute decompensation or acute-on-chronic liver failure (ACLF) necessitating management in the critical care unit. It has also been shown that downstaging ACLF grade before transplantation improves outcomes, thus emphasizing the importance of appropriate management of these patients during admissions to critical care units. This cohort of patients has a very delicate reserve and fine balance with other organ functions. Any form of decompensation can rapidly result in other organ failures. Prompt and aggressive management of the precipitating cause and supporting existing organ failures is essential to avoid cascading organ failures in this group of patients. To address the common causes for admission to liver intensive care, we present an outline on critical care management of patients presenting with hypovolemic shock due to gastrointestinal bleeding, altered sensorium, acute kidney Injury, and septic shock.