Managing acute liver failure

Abstract 

Acute liver failure in childhood is a rare but fatal disease with a mortality of 70% without transplantation. The aetiology depends on age. In neonates, sepsis or an inherited metabolic liver disease is most likely, whereas viral hepatitis or drug-induced liver failure, especially following paracetamol overdose, is common. The clinical presentation includes jaundice, coagulopathy and encephalopathy. Early diagnosis is essential in order to prevent complications such as cerebral oedema, gastrointestinal bleeding and renal failure. Poor prognostic features include a reduction in liver size, a rising bilirubin with fall in hepatic transaminases, and increasing coagulopathy. Early supportive management, particularly intravenous N-acetylcysteine, may be effective but, in most instances, liver transplantation will be the definitive treatment and thus early referral to a specialist unit for liver transplantation is mandatory.

Keywords: paediatrics, fulminant hepatitis, acute liver failure

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• f1 E-mail: d.a.kelly@bham.ac.uk