Acute Liver Failure in Children


Liver failure, also known as acute hepatitis, is relatively uncommon in children but the mortality rate can be as high as 70%. Early detection of an acute liver failure in children helps to detect early and treat the disease promptly, avoiding unfortunate consequences.

What causes acute liver failure in children?

In infants / Children up to 6 months of age, there’re some widespread reasons that cause acute liver failure

  • Septicemia
  • Hepatitis B
  • Neonatal hypertriglyceridaemia
  • Type I tyrosine deficiency
  • Mitochondrial disorders
  • Defects in acid oxidation Fatty
  • Paracetamol poisoning
  • Familial hyperplasia syndrome …

 In infants over 6 months of age, the cause is triggered by:

  • Hepatitis A / B / E / non-AG virus
  • Epstein-Barr virus
  • Parvovirus B19
  • Autoimmune hepatitis type I or II
  • Paracetamol overdose
  • Sodium valproate
  • Carbamazepine
  • Isoniazid
  • Halothane
  • Wilson disease, Alpers disease, etc.

Signs of acute liver failure in children

Clinical manifestations depend on the cause of the disease. Acute manifestations can occur within a few days or last up to 10 weeks if the cause is due to liver disease.

They may have

  • Jaundice
  • Vomiting
  • Poor feeding
  • Increased agitation or convulsions
  • Encephalopathy.

The level of jaundice and encephalopathy are different in the early stages of the disease but all children have encephalopathy. Encephalopathy is especially difficult to diagnose in infants. In older children, encephalopathy may be manifested by increased agitation or convulsions.

Diagnosis and treatment

Diagnosis of acute liver failure based on standard tests of liver function and blood coagulation. Contraindication of liver biopsy due to abnormalities in blood coagulation. However, in case of necessity, the biopsy may be done through a vein of sight. Depending on the cause of the disease, doctors will perform more specific tests.

Management of acute liver failure in children includes active supportive treatment and referral to specialist pediatric liver specialist centers for early consideration of liver transplantation. The goals of treatment are:

  • Prevent complications such as hepatic encephalopathy, cerebral edema, septicemia, gastrointestinal bleeding, renal failure and multiorgan failure.
  • Proper assessment of prognosis and consideration of liver transplantation.
  • Treatment supports liver function.
  • The restriction remains 75% of the need for normal maintenance to prevent cerebral edema and hepatic encephalopathy.
  • Maintain blood glucose levels> 4.0 mmol / l.
  • Prevention of gastrointestinal bleeding with ranitidine 3 mg/kg and sucralfate 2-4 g / day.
  • Prevent septicemia with broad spectrum antibiotics and anti-fungal drugs.
  • Control of blood coagulation disorders with vitamin K (2-10 mg); Treatment of severe coagulopathy (when prothrombin time> 60 seconds) with fresh frozen plasma and cryoprecipitate.

Acute liver failure is a liver necrosis accompanied by encephalopathy that occurs within 8 weeks of onset of liver disease. Acute liver failure in children with clinical manifestations can be prolonged, especially in the case of secondary liver failure following hepatic or autoimmune disease.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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