Pediatric emergency medicine trisk 2083 2083
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TABLE 91.5
ETIOLOGY OF ACUTE LIVER FAILURE BY AGE GROUP
Less than 1 yr (%)
>1 yr (%)
Metabolic a (42)
Unknown (47)
Neonatal hemochromatosis (16)
Undetermined (16)
Viral hepatitis
Non-A and non-B (27)
Hepatitis A (10)
Viral hepatitis (15)
Hepatitis B (4)
Other (10)
Drug induced b (10)
Other (2)
a Type
1 tyrosinemia, mitochondrial, urea cycle disorder, galactosemia, fructose intolerance.
amanita, isoniazid, valproic acid.
Adapted from Cochran JB, Losek JD. Acute liver failure in children. Pediatr Emerg Care
2007;23(2):129–135.
b Acetaminophen,
The development of hepatic encephalopathy (HE) is not seen in children as
frequently as in adults, but when seen, is more common in patients with non–
acetaminophen-induced ALF. The Pediatric Acute Liver Failure Study Group
evaluated children with ALF in North America and Europe and found that on
presentation 57% of nonacetaminophen and 40% of acetaminophen groups
had clinical evidence of HE.
Clinical Considerations
Clinical Recognition. Patients often do not exhibit serious clinical features of
ALF. Patients may present with nonspecific prodromal symptoms or in septic
shock. Often children present with multisystem disease or sepsis, making the
diagnosis of primary ALF challenging. Adult definitions, which rely on HE,
are often not reliable in children.
Triage Considerations. Many patients simply present with nonspecific
prodromal symptoms such as fatigue, nausea, and vomiting. Others may
present in shock with multisystem organ failure. As with any life-threatening
condition, patients should be triaged and treated accordingly.
