Son of Chief Mataio Kekuanaoa & Princess Kinaʻu (daughter of Kamehameha), Prince Alexander Liholiho was born on February 9, 1834, he was officially claimed eligible for the throne by his uncle, Kamehameha III, who adopted him and directly claimed him heir to the throne which he succeeded on December 15, 1854, taking on the title of Kamehameha IV. The King married his cousin, Princess Emma Rooke Naʻea and had one child, Prince Albert Edward Kauikeaouli, who was the crown prince and heir to the throne. Queen Victoria of England was the godmother of the young prince. Unfortunately, he died at the age of 4.
In 1859, Kamehameha IV was very concerned about disease and the well being of his people that he solicited funds himself along with Queen Emma to build a grand hospital in Honolulu and named it in honor of his Queen Emma, still in existence today.
King Kamehameha IV died on November 30, 1863, his brother, Prince Lot succeeded him and became King Kamehameha V.