THE CRITICALLY ILL CHILD: ACUTE HEPATIC FAILURE

Abstract

The presumed causes of liver failure in 42 children are discussed. The aim of treatment (summarized in the Appendix) is to maintain the child until the liver function is improved. Other causes of coma must be investigated; hypoglycemia, infection, electrolyte imbalance, or gastrointestinal hemorrhage must be prevented if possible or promptly recognized and treated if they occur. Dietary protein is restricted, and alimentary protein breakdown by bacteria is decreased by oral antibiotics and purgatives. Glucocorticosteroids may be administered. If the deeply comatose child does not improve or deteriorates rapidly, procedures such as exchange blood transfusions should be used. All aspects of therapy may be required in the child recovering from the acute phase or in those with chronic liver failure. The mortality is high, and prevention or early detection of this syndrome is important.