Acute liver failure (ALF; or fulminant hepatic failure) is a loss of liver function that occurs very rapidly, usually in days or weeks, in a person with no pre-existing liver disease. This type of liver failure is much less common than chronic liver failure, which develops more slowly.
ALF can cause serious complications, including excessive bleeding and increasing pressure in the brain. Other organs throughout the body may begin to fail. This is a life-threatening medical emergency that requires hospitalization, often in the critical care unit.
Acute liver failure can occur for many reasons, but is often caused by drugs or toxins, or the result of a viral infection (most likely hepatitis). Some patients also have genetic conditions which lend themselves to liver failure. In about half of all cases, an exact cause can’t be identified. In the United States, there are about 2,000 cases of acute liver failure per year, making it a rare clinical syndrome.
Acetaminophen overdose is a leading cause acute liver failure in the modern world, especially among children. When taken within recommended dosages, acetaminophen (Tylenol’s main ingredient) is seen as safe and effective. But when taken in excess, this pain reliever can cause serious damage to the liver and lead to ALF. Overdose may be purposeful or happen by accident - especially since acetaminophen is added to many (over 600 in total!) prescription and over-the-counter medications and is sometimes called “Paracetamol” or “APAP”. Reading warning labels is crucial.
The antidote to acetaminophen overdose is intravenous N-acetylcysteine (NAC). This drug is most effective when given within eight hours of ingesting acetaminophen. If you suspect that you or loved one has taken too much acetaminophen, go to your nearest emergency room immediately.
At SSM Health Cardinal Glennon Children’s Hospital, our team of experts is passionate about helping children with liver conditions live long, healthy lives and is committed to offering the latest advancements in care. If your child has been diagnosed with liver failure, call us today at 314-268-4010 to schedule an appointment to learn how we can help.
Symptoms of Pediatric Acute Liver Failure
The signs of acute liver failure usually present themselves very quickly and unexpectedly. The first symptom for many adults is an altered mental state (encephalopathy), such as sudden personality shifts or confusion. Infants and children may not experience encephalopathy or exhibit noticeable signs, but will usually have jaundice symptoms (yellowing of the skin and whites of the eyes).
Other common symptoms:
- Bleeding (coagulopathy; problems with blood clotting)
- Extreme fatigue
- Nausea or poor appetite
- Abdominal discomfort
- Enlarged liver and/or painful abdomen
Kidney failure is common in those with ALF, occurring more than 50% of the time. Other organs may also be affected, and bacterial and fungal infections are common.
If you suspect that you or loved one has symptoms of acute liver failure, go to your nearest emergency room immediately.
Diagnosis of Acute Liver Failure
The exact definition of “rapid” decline of liver function when referring to ALF is up for debate, but one thing is clear – time is of the essence when a patient is experiencing acute liver failure. Diagnosis of the problem and immediate medical intervention is crucial.
In addition to physical exams, numerous blood tests and/or genetic testing may also be done to help diagnose the problem. Imaging tests or a liver biopsy so your doctor can examine your child’s liver tissue more closely may also be recommended.
Treating Acute Liver Failure in Children
Treatment options for acute liver failure depend on its cause. Some ALF cases are reversible, meaning the liver may heal itself once the underlying issues are addressed. (Many patients with hepatic failure due to viral infection are in this category). In these cases, supportive care to treat symptoms and promote healing is the focus.
As noted, N-acetylcysteine (NAC) is given to those with acetaminophen overdose; this drug may also help patients with cardiovascular problems. Other medications may be prescribed to address symptoms.
Avoiding substances known to cause liver damage, as well as dietary management and supplementation to ensure children get the proper nutrients, are other essential steps for people with this condition.
*The FDA currently recommends that anyone taking medications which contain acetaminophen should not drink alcoholic beverages.
For those with more severe or non-responsive cases of acute liver failure, the next treatment option is liver transplantation. About 40% of children with ALF will eventually need a transplant. Fortunately, this group of patients has a favorable long-term outlook as well when given appropriate care.
We understand that learning your child has fulminant hepatic failure or any chronic medical condition can be a very stressful time for your family! That’s why our SLUCare Physician Group surgeons at Cardinal Glennon Children’s Hospital are here to support you every step of the way. Call us today at 314-268-4010 to schedule an appointment or to request a second opinion.