Overview of acute liver failure in children
Severe liver failure occurs when many cells in the liver die or are severely damaged in a short period of time. This makes the liver not work. As a result, patients can become less alert or go into a coma. Since it happens so fast, it is very necessary to get care quickly. Severe liver failure in children is very rare.
Symptoms of acute liver failure in children
Symptoms of acute liver failure include loss of appetite, nausea, vomiting, yellowing of the skin and eyes, and viral infection, such as feeling tired all the time. These symptoms quickly develop into a tendency to bleed, irritability, excessive sleepiness, and unconsciousness (encephalopathy).
A change in consciousness or encephalopathy occurs when a child has sudden and severe liver failure. Babies as young as 28 days may not have noticeable signs of encephalopathy, however, they may have other symptoms as described above. Babies older than 28 days may be fussy, have crying spells and may not feel well, or may want to sleep more during the day than at night.
Causes of acute liver failure in children
There are many causes of severe liver failure. Acetaminophen (like Tylenol) is a common drug that affects liver function. This can happen if children get the wrong dose of medicine or take too much in a short time.
Other causes of acute liver failure include:
- Metabolic conditions (problems with the physical and chemical processes within the liver that a person must live with)
- Infections / viruses
- Immune dysfunction
- Cardiovascular conditions (causes lack of blood supply to the liver)
- Oftentimes, the cause of severe liver failure in children is not found. One study found that 44 percent of children with severe liver failure had a similar condition. This figure is 63 percent of children under 2 years of age with severe liver failure.
Causes of Chronic liver failure
- Infections: Herpes simplex, ecovirus, adenovirus, hepatitis B, Parvovirus
- Drugs / Toxins: Acetaminophen
- Cardiovascular: Extracorporeal membrane oxygenation, hypoplastic left heart syndrome, shock, asphyxia, myocarditis
- Metabolism: Galactosemia, tyrosinemia, iron storage, mitochondrial condition, HFI, fatty acid oxidation, etc.
- Immunity: Autoimmune hepatitis, immune regulation, immunodeficiency, hemophagocytic lipohistiocytosis
Diagnosis of acute liver failure in children
To diagnose liver disease, doctors usually look at the child’s symptoms and perform a physical exam. The following tests are used to diagnose
- Blood test: A child’s blood sample can be tested for the following signs of liver disease:
- Albumin: A protein produced by the liver and found in the bloodstream and below normal levels, is associated with many liver disorders.
- Bilirubin: It is produced by the liver and excreted in the bile. Elevated bilirubin levels indicate a problem with the liver.
- Liver enzymes: Liver enzymes, levels of liver enzymes alert doctors to liver damage or injury.
- The prothrombin time (PT) test: Measures the time it takes for blood to clot. Since blood clots require vitamin K and proteins made by the liver, damage to liver cells and obstruction of bile flow can interfere with proper blood clotting.
- Abdominal ultrasound(also known as ultrasound): Allows doctors to observe a child’s liver function and assess the blood flow through different vessels.
- A liver biopsy: A liver biopsy procedure is done under a microscope to examine a small sample of liver tissue. In addition to helping diagnose liver disease, the biopsy can give doctors a better idea of the extent of the damage and make decisions about the best treatment for the child.
- A computed tomography (CT or CAT): CT scan is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to show a detailed image of internal organs, such as the liver. The images from a CT scan are only more detailed than X-rays.
- To find out the cause of acute liver failure
- To assess the severity of the liver failure
- Detect any problems in advance
Treatment for acute liver failure in children
Treatment of acute liver failure depends on the cause of the disease. Some causes can be treated with medications or a liver transplant.
- Supportive care: There are some patients who will get better on their own if they are treated for their symptoms. Most patients with the virus get better on their own. Your liver can turn into a healthy organ.
- Medication: When severe liver failure is caused by a cardiovascular condition or acetaminophen, it can sometimes be treated with medication. Medications can reverse it if given in advance. Metabolic diseases can be treated with medicine or food if irreversible damage has not yet occurred.
- Transplantation: A liver transplant is required for the survival of 40 percent of children with severe liver failure. For many patients whose cause of liver failure is unknown, transplantation is the only option. Depending on whether a liver transplant is recommended for children:
- If the cause of the disease is known
- The conversion is likely to be successful
- If there is a disease in more than one organ or part of the body.
- The amount of brain damage
- The chances of brain damage are reversed after a liver function transplant.
- Treatment of encephalopathy: Hepatic encephalopathy always develops when liver failure is sudden and severe. This is trying to prevent the production of toxic products in the liver, which can cause the condition.
- Treating coagulopathy: Medications or blood products may be needed if blood clotting problems become dangerous.
Complications of acute liver failure in children
Abnormal bleeding: The liver plays an important role in the production of proteins that help the blood clot. If the liver is not working properly, it may not be produced and may bleed anywhere in the body. Measuring the rate of blood clotting is a useful way to assess whether this is a problem. Blood clotting factors must be given to treat it.
Infection: The liver plays an important role in fighting infection. Children with severe liver failure are more likely to become infected. Your child may be given antibiotics and antifungal medications through a vein (intravenously) to prevent infection. Any specific infection identified will be treated.
Encephalopathy: Encephalopathy is caused by the liver not properly removing toxins from the blood. This can cause irritation and inflammation of the brain. If your child’s level of consciousness is declining, causing drowsiness, irritability, or behavior problems, they should be cared for in intensive care. The ventilator should be used to allow the child to fully relax and receive further treatment.
Encephalopathy is very difficult to diagnose and varies from minute to minute. For example, one minute a young child may be sleeping a lot and the next minute he or she may be drinking a bottle in bed.
Poor kidney function: The kidneys may not work when the liver fails. In this case, the child receives drip fluids and medications. They may need a urinary catheter to accurately measure their urination. Some children may need less time to help with kidney dialysis.