Acute liver failure

SummaryAcute liver failure (ALF) is a rare disorder in children but carries a high mortality without liver transplantation. Certain metabolic disorders and infections causing liver failure can, however, be managed with dietary changes and medications, avoiding liver transplantation, particularly in neonates. A prothrombin time that cannot be corrected by a single intravenous dose of vitamin K in a child with abnormal liver tests should prompt emergency discussion with a centre specialising in the management of children with liver disease and transplantation. Management while awaiting transfer to a specialist centre involves the maintenance of euglycaemia, fluid and electrolyte balance, and the administration of broad-spectrum antibiotics. The role of liver-support devices has not been established in children. Liver transplantation is now the accepted treatment, with good long-term survival.