A number of definitions for acute liver failure (ALF) have been proposed. These mostly deal with adults and have failed to address the complexities associated with infants and children. Pediatric ALF can be defined as: Evidence of liver dysfunction within eight weeks of onset of symptoms (neonates may have only deranged liver functions) Uncorrectable coagulopathy with International Normalized Ratio (INR)>1.5 in patients with hepatic encephalopathy or INR>2.0 in patients without encephalopathy. No evidence of chronic liver disease either at presentation or in the past.
Management in the ICU It is advisable that the child is nursed in a quiet environment, and hence, an intensive care setting should be preferred. Here are some general recommendations about patient monitoring: The fluids should be glucose-based and administered at the infusion rate of at least 4-6 mg/kg. Vasoactive drugs…
