Pediatric emergency medicine trisk 2082 2082
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Current Evidence
ALF in children can be secondary to a variety of causes, however all result in
the progression of irreversible hepatocyte injury. In children younger than 1
year of age, ALF most commonly occurs in the setting of a metabolic disease
such as urea cycle disorders, galactosemia, type I tyrosinemia, or an
underlying mitochondrial disorder (see Chapter 95 Metabolic Emergencies ).
Other causes include viral hepatitis such as herpes simplex or enterovirus and
medications such as acetaminophen. In children older than 1 year of age, the
etiology is not determined in half of all cases ( Table 91.5 ). In identified
cases, pharmaceutical agents such as acetaminophen or antiepileptic drugs are
the most common causes. Importantly, prolonged and inappropriate
acetaminophen dosing is likely an important contributor to ALF in children,
however it is much more difficult to assess with current testing mechanisms,
which more accurately assesses for acute toxicity (see Chapter 102
Toxicologic Emergencies ). Metabolism of acetaminophen is known to be
quite variable, and there are likely patients who are slow metabolizers that
may increase their risk of ALF with prolonged use, even when correct weightbased dosing is given. Other causes include autoimmune hepatitis and
infections such as viral hepatitis. Herbal drugs have also been known to cause
ALF. In developing countries, viral hepatitis is by far the most common
etiology of ALF in all age groups of children.
