What Is Fulminant Hepatic Failure (Acute Liver Failure) in Children?
Acute liver failure is also called fulminant hepatic failure or "FHF." The word "hepatic" refers to the liver; "fulminant" means to strike suddenly, like lightning. Fulminant hepatic failure is uncommon, but not rare. It happens when liver cells are injured and die. These liver cells are replaced by scar tissue instead of normal liver cells; this continues until there are not enough liver cells to do their job. Not only does fulminant hepatic failure interfere with liver function; it also has secondary effects on other organ systems. It can affect the brain, causing encephalopathy (en-seh-fuh-luh-pa-thee) within two to twelve weeks.
Acute liver failure is caused by a serious insult to the body, usually viruses or toxins that overwhelm the liver. The most common cause of acute liver failure is viral hepatitis. A drug overdose, such as acetaminophen or Tylenol®, may also cause fulminant hepatic failure. Other causes may be eating some natural products such as some mushrooms or medicinal herbs. Or, you can get fulminant hepatic failure if you are exposed to toxic chemicals or poisons. Sometimes it is not known what causes fulminant hepatic failure.
Often because of exposure to viruses and toxins, acute liver failure can occur in healthy people with no previous liver disease. In infants and children, inherited disorders affecting the liver are more likely to play a role in fulminant hepatic failure than in adults.
Acute Liver Failure Symptoms and Diagnosis in Children
Diagnosing acute liver failure can be difficult, because its early symptoms are nonspecific: nausea and vomiting followed by jaundice and rapidly changing mental status. These could be caused by other problems as well. A closer look at the symptoms of someone with acute liver failure might reveal:
- Ascites (uh-sih-tees), or swelling of the abdomen when too much fluid builds up inside
- Bruising and bleeding very easily
- Dark, tea-colored urine
- Light-colored stools (bowel movements)
- Fatigue (feeling tired) and weakness
- Itchy skin
- Strong feelings of irritation or confusion, not thinking clearly
- Jaundice (jon-diss) – yellow skin, eyes, and gums
- Loss of appetite
- Swollen feet and legs (edema)
If doctors think a person is experiencing acute liver failure, they will quickly perform tests to confirm or rule out the diagnosis. These tests may also be needed to help caregivers decide on the best treatment plan for an individual with acute liver failure.
Acute Liver Failure Treatment
If the cause is found and can be treated, acute liver failure can be stopped. Although liver regeneration is possible, liver damage severe enough to cause acute liver failure often cannot be reversed. This is why most people who have fulminant hepatic failure will need a liver transplant. However, the acute liver failure symptoms can be lessened and controlled during the wait for a healthy liver.
Doctors may recommend a special diet to cut down on the protein and sodium a person eats, while also making sure there are enough calories included to keep up energy. Vitamin supplements may also be prescribed.
Different medicines may be used to treat the side effects of liver failure. Some of these medicines help clean out toxins that the liver normally removes, such as ammonia. Others help the extra fluid in the brain, legs, feet, and abdomen move back into the blood stream. Extra bile salts that can cause itching can also be removed with medication. Medication can also help lessen diarrhea, which may make eating easier.
Some of these treatments may be given on their own, or along with other treatments. Doctors will monitor how well the treatments are working with more tests, and modify those treatments to keep patients as healthy as possible before a donor liver can be found.
Learn about other Liver Disease States.
