Hepatic failure (pediatrics)

Fulminant liver failure (FLF) is rare in children. The most common cause is hepatitis A, but often the etiology has not been established.

Definition We define it as an acute liver disease with the onset of encephalopathy within 8 weeks of the clinical manifestation of jaundice, without a previous history of chronic liver disease. In pediatrics we define it as- an acute liver disease that develops a vitamin K-unresponsive coagulopathy from the first symptoms to 8 weeks, where INR is> 1.5 and encephalopathy occurs or INR> 2 without encephalopathy (in addition to standard biochemical parameters of liver damage).

Pathogenesis
The causative agent damages hepatocytes → liver cell necrosis → liver failure. Synthetic, excretory and detoxification functions of the liver are impaired → hepatic encephalopathy. High levels of ammonia and glutamate lead to brain edema and circulatory collapse in the CNS.