Acute Liver Failure
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- A set of criteria has been proposed to diagnose pediatric acute liver failure (ALF).
- Biochemical evidence of liver injury due to rapid loss of hepatocyte function
- No previous history of chronic liver disease
- Coagulopathy not responsive to vitamin K administration
- International normalized ratio (INR) >1.5 in presence of encephalopathy or INR >2 without encephalopathy
- In older children, in whom hepatic encephalopathy can be more easily assessed, ALF may more simply be defined as follows:
- Onset of encephalopathy <8 weeks after the onset of symptoms referable to liver dysfunction in a patient without preexisting liver disease
- Exact frequency of ALF in children is unknown but accounts for 10–15% of pediatric liver transplants in the United States annually.
- In infants and children <3 years of age, indeterminate and metabolic etiologies predominate.
- In older children, drug-induced toxicity (especially acetaminophen), autoimmune hepatitis become more common.
- Infectious etiologies (e.g., viral hepatitis) vary in prevalence based on geographic region.
- Hepatocellular necrosis leads to release of growth factors that promote hepatic regeneration.
- Hepatic failure may become irreversible if:
- The initial insult overcomes the liver’s regenerative capacity.
- The offending agent or derangement is not eliminated or corrected.
- Secondary complications, such as shock or disseminated intravascular coagulation, lead to further injury.
The major causes of ALF can be grouped into the following broad categories:
- Immune dysregulation