Pediatric emergency medicine trisk 2081 2081
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LIVER DISEASE
Acute Liver Failure
Goal of Treatment
Acute liver failure (ALF) in children occurs when the vital synthetic functions
of the liver fail (coagulopathy) in the setting of known hepatic injury but
without chronic liver disease. ALF can be associated with hypoglycemia,
hyperbilirubinemia, hypoproteinemia, and occasional encephalopathy. Liver
failure can develop acutely, or it may be chronically progressive. ALF is a
clinical syndrome due to a myriad of etiologies including infections (e.g., viral
hepatitis) and metabolic diseases (e.g., Wilson disease). Clinical presentation
can be quite variable. The goal of the ED provider is early recognition of ALF
in the setting of nonspecific signs and symptoms. In patients with recognized
liver failure, the ED physician should address acute and common
complications such as electrolyte imbalances, hypoglycemia, and
encephalopathy. In addition, patients are often coagulopathic, which should be
corrected in the setting of active bleeding. If there is no active bleeding,
correction of a coagulopathy should be weighed against the risk of volume
overload. Finally, patients with ALF are at very high risk for infection and
should be treated aggressively if one is suspected.
CLINICAL PEARLS AND PITFALLS
Childhood ALF may be diagnosed in the setting of coagulopathy,
evidence of hepatic injury, and in the absence of chronic liver
disease.
Children with ALF may not present with hepatic encephalopathy or
asterixis.
Hypoglycemia is a common complication of ALF.
Coagulopathies in patients with ALF are difficult to correct and
aggressive attempts at correction may lead to volume overload.
Renal function should be monitored closely.
Patients with ALF are at high risk for infectious complications and
should be treated aggressively if infection is suspected.
