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Acute Liver Failure, Pediatric

Shreena Patel, MD, K. Lynette Van Buren, MD, MEd and Eric H. Chiou, MD Reviewed 10/2018
 


BASICS

DESCRIPTION

  • 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 o...

DIAGNOSIS

HISTORY

  • Age: may suggest possible etiologic subgroup

  • Toxin exposure: prescription, over-the-counter, herbal, or supplemental medications

  • Symptoms of viral prodrome (fever)

  • Travel history, exposu...

TREATMENT

GENERAL MEASURES

  • Close monitoring, preferably in an ICU setting with a liver transplant program

  • General supportive care:

    • Fluid restriction: 75–95% of maintenance requirements to prevent worseni...

ONGOING CARE

PROGNOSIS

  • Etiology of ALF provides good indicator of prognosis and also dictates management.

  • One half of pediatric ALF patients will die or receive liver transplant.

  • Existing liver failure s...

ADDITIONAL READING

  • Bass NM, Mullen KD, Sanyal A, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med.  2010;362(12):1071–1081. [View Abstract on OvidInsights]

  • Bucuvalas J, Yazigi N,...

CODES

ICD9

  • 570 Acute and subacute necrosis of liver

ICD10

  • K72.00 Acute and subacute hepatic failure without coma

  • K71.10 Toxic liver disease with hepatic necrosis, without coma

SNOMED

  • 197270009 Acute hepatic...

FAQ

  • Q: What are the most common causes of ALF in infants?

  • A: Up to 40–50% of cases are indeterminate, followed by neonatal hemochromatosis, viral infection, and metabolic disorders.

  • Q: What is the risk ...

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