Paediatric acute liver failure: a practical approach

Published:October 28, 2021DOI:


      Acute liver failure (ALF) in the paediatric patient is a multisystem complex disorder, which occurs in the absence of chronic liver disease. Globally, viruses remain a common cause but drugs, metabolic and autoimmune conditions are important triggers. In up to half of cases no specific cause is identified. The definition entails a coagulopathy with a Prothrombin time (PT) ≥ 15seconds or International Normalized Ratio (INR) ≥ 1.5 not corrected by vitamin K in the presence of hepatic encephalopathy (HE) or a PT ≥ 20 or INR ≥2 or above regardless of HE. HE can be difficult to recognize in children and is defined differently than HE in adults. Timely recognition of ALF improves outcomes and allows time to undertake investigations, provide supportive therapy and arrange transfer to a specialist paediatric liver centre with transplant capacity. The purpose of this article is to review the aetiologies of ALF in children and outline an approach to investigation, management and treatment.


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      Further reading

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        Effect of continuous renal replacement therapy in outcome in paediatric acute liver failure.
        Crit Care Med. 2016 Oct; 44: 1910-1919
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        King's College Hospital Criteria for non-acetaminophen induced acute liver failure in an international cohort of children.
        J Pediatr. 2013; 162 (e1): 319-323