Acute liver failure
in children
Acute liver failure is a rare, serious condition where liver cells suddenly die or stop functioning normally. It usually happens suddenly and can feel quite overwhelming. The early symptoms are often similar to common childhood illnesses so families and healthcare professionals often don’t identify it at first.
Also called: Fulminant liver failure or ALF
The information on this page is for:
- Parents of children with acute liver failure or suspected ALF.
- Family, friends, carers, and healthcare professionals.
On this page:
What is acute liver failure?
Acute liver failure is when liver cells suddenly die or stop functioning normally. It may happen suddenly over a few days or more gradually over weeks.
What can cause acute liver failure?
Some possible causes include:
- infections
- metabolic diseases
- autoimmune liver disease
- blood disorders
- medication (including alternative medicines)
- paracetamol overdose (often accidental)
- recreational drugs, especially ecstasy
- poisonous substances
- complications caused by another illness
In many cases it is not possible to find a specific cause.
What are the signs and symptoms of acute liver failure?
The signs and symptoms can vary but often include:
- general symptoms of feeling unwell
- abdominal pain
- nausea and vomiting
- weight loss
- jaundice
- poor blood clotting (coagulopathy) which may cause bruising and bleeding
- low blood sugar levels (hypoglycaemia)
- fluid and salt imbalance including swelling e.g. abdominal swelling and lower leg swelling
- encephalopathy (changes within the brain’s functions) can cause symptoms ranging from a loss of concentration and irritability to drowsiness
Why does my child need to go to a specialist hospital?
Your child will be transferred from a local hospital to a specialist centre so they can be looked after by a team who have more experience looking after children with acute liver failure.
The team caring for your child will:
- recognise and treat complication as early as possible
- look for the cause of the acute liver failure and, if found, start appropriate treatment
- support you child’s vital functions – your child may need to be cared for in the intensive care unit
- prepare your child for a liver transplant in case this becomes necessary
There may be clues about the cause of your child’s current illness from their previous overall health and development. You are likely to be asked many questions by a number of different people. Some of the questions may seem strange but are important. You may be asked about changes in your child’s behaviour. This can suggest the development of encephalopathy which can be caused when the liver is not working properly.
Find out about specialist paediatric liver centres in the UK
What tests may be needed?
The tests will vary for each child and the clinical team will discuss these with you.
Tests may include:
- blood tests, including liver functions tests (LFTs) and tests to measure blood clotting
- urine tests
- X-rays or scans
- liver biopsy – this may be a special type of biopsy called a transjugular biopsy, which is safer for children if their blood isn’t clotting properly
- skin and muscle biopsies
Some test results are available the same day, but others can take longer.
The purposes of the tests are:
- to find out the cause of the acute liver failure
- to assess how severe the liver failure is and whether it is getting better or worse over time
- to detect any possible complications early
What are the complications of acute liver failure?
Complications may include:
Abnormal bleeding
The liver plays an important role in producing proteins, called blood clotting factors, which help the blood to clot. If the liver isn’t working properly, these may not be produced which can lead to bleeding in any part of the body.
Measuring the rate of blood clotting is a useful way to assess whether the liver is getting better or worse. Blood clotting may only be treated if there is bleeding or your child needs any procedures that may put him/her at risk of bleeding. Blood clotting factors may need to be given to treat this.
Infection
The liver plays an important part in fighting infection. Acute liver failure makes it more likely for a child to get an infection. Your child may be given intravenous (through the vein) antibiotics and anti-fungal medicines to prevent infection. Any specific infection identified will be treated.
Encephalopathy
Encephalopathy can occur because the liver is unable to clear toxins from the blood properly. This can lead to irritation and swelling of the brain.
If there is a decrease in your child’s level of consciousness, leading to drowsiness, irritability or behaviour which is out of character, they may need to be cared for in an intensive care unit. A ventilator (breathing machine) may need to be used to allow a child to completely rest and enable additional treatment to be given.
Other treatments such as a form of dialysis may also be needed to try and rid the body of toxins.
Encephalopathy can be very difficult to assess and it can change from one minute to the next. For example, one minute a young child may be very sleepy and the next minute they may be sitting up in bed drinking a bottle.
Poor kidney function
When the liver fails the kidneys may not work as well as they should. In this case children are given fluids via a drip and a medicine to help them pass urine. They may also need a urinary catheter to accurately measure their urine output. Some children may need help from kidney dialysis for a short time.
When is liver transplantation needed for children with acute liver failure?
Some children make a complete recovery without the need for liver transplantation. The liver has the ability to recover quickly despite significant injury and sometimes a full recovery is possible.
If your child’s liver will not recover by itself and the doctors think that a liver transplant is the best option, your child will be referred to the transplant coordinator. They will register your child and provide you with more information on the transplant process. Supportive care and treatment will continue.
Your child will have to wait for a suitable liver which is matched in terms of blood group and size. Children with ALF are given priority. Most children receiving a liver transplant will make a full recovery and although they will require lifelong medication, the majority will be able to lead a normal life.
Looking after yourself
If your child gets ill very quickly the stresses and demands placed on you may affect you physically. It is important that you look after yourselves and accept any support offered.
When you are in hospital with your child you should try to take rest breaks when possible. Remember to eat and catch up on sleep whenever you can.
There is a lot to understand and come to terms with in a short space of time and asking questions is really important. You will be offered opportunities to meet with the team looking after your child and you can talk to the team about any questions you have. It might help you to write these down as they come to you so you remember what you would like to ask.
Other family members, for example grandparents, can feel isolated and helpless. As well as the concern for their grandchild, they will also be worried about their children. It often helps if you keep everyone informed about your child’s condition and have leaflets for other family members to read so they understand what is happening.
Useful words
Acute – a short illness. Acute illness comes on suddenly and can be severe
Encephalopathy – changes in the brain that can effect how it works
Fulminant – a sudden and very severe illness
Jaundice – a condition where the skin or eyes turn yellow
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This content was last reviewed: September 2020
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We would like to thank everyone who helped with creating and reviewing this page. Information within this leaflet has been produced with input from the three specialist paediatric liver centres in the UK. And with parents and families.
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Everyone’s experience of liver disease will be different. Always talk to your specialist medical team for personal advice.
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