Acute and Chronic Liver Failure – in Children

Symptoms of acute liver failure in children includes:

• Jaundice (yellowing of the skin and eyes)
• Nausea, vomiting, and abdominal pain
• Fatigue and lethargy
• Confusion or irritability (due to metabolic disturbances)
• Easy bruising or excessive bleeding.

Symptoms of chronic liver failure in children include:

• Persistent jaundice
• Poor growth and malnutrition
•  Fluid buildup in the abdomen (ascites)
• Frequent infections
• Mental confusion (hepatic encephalopathy).

For children with acute liver failure, early diagnosis and treatment are essential. Tests used for diagnosis include blood tests, liver function tests, imaging (ultrasound, MRI), and sometimes liver biopsy.

Chronic liver failure is diagnosed using blood tests, imaging studies, and sometimes liver biopsy.

Treatment options for acute liver failure in children include:

• Supportive care – monitoring vital functions and preventing complications.
• Medications – N-acetylcysteine (NAC) for paracetamol toxicity, antivirals for infections.
• Plasma exchange or dialysis to help remove toxins from the bloodstream.
• Liver transplantation – the only life-saving option for children with irreversible liver failure.
   

For children with chronic liver failure, treatment focuses on managing symptoms and slowing disease progression:

• Nutritional support such as special diets and supplements to support growth and development.
• Medications to manage symptoms and prevent complications.
• Paracentesis to remove excess fluid from the abdomen.
• Liver transplantation – the only curative treatment for end-stage liver failure.

Acute liver failure (ALF) in children is caused by viral infections such as Hepatitis A, B, and E, as well as other viruses such as Epstein-Barr virus or cytomegalovirus, metabolic diseases – genetic conditions such as Wilson’s disease or mitochondrial disorders, drug toxicity due to overdose of medications particularly paracetamol (acetaminophen) or adverse drug reactions, autoimmune hepatitis - when the immune system mistakenly attacks the liver, and toxin exposure due to ingestion of poisonous substances, including certain plants or chemicals.

Chronic liver failure (CLF), also called end-stage liver disease, develops over months or years due to progressive liver damage. The most common cause is cirrhosis, where healthy liver tissue is replaced with scar tissue, impairing liver function.

Causes of chronic liver Failure in children includes biliary atresia – a condition in newborns where bile ducts are blocked or absent, genetic metabolic disorders including Wilson’s disease, alpha-1 antitrypsin deficiency, and glycogen storage diseases, chronic hepatitis as a result of long-term viral infections or autoimmune diseases, non-alcoholic fatty liver disease often linked to obesity and metabolic disorders, and cystic fibrosis-related liver disease – a complication of cystic fibrosis affecting the liver.

At Karolinska University Hospital, our experienced team can provide comprehensive diagnosis, treatment, and rehabilitation.