1014 Critical Care Management of Fulminant Hepatitis

Abstract

Background:Fulminant hepatitis in pediatrics is the result of acute liver failure, and it may have multiple causes. Without support therapy and/or liver transplantation, mortality may reach 70% or more. The developments of fulminant hepatitis in adults, including liver necrosis and encephalopathy within 8 wees, are different than those in pediatrics, especially if fulminant hepatitis is secondary to a metabolic or autoimmune disease. Congenital metabolic defects and infections are common in infants, whereas viral hepatitis and drug-induced liver failure are more common in older children. Goals: Screening for infections and drugs is important to determine the cause of liver failure. The biochemical features evidence significant conjugated hyperbilirubinemia, high aminotransferase, high blood ammonia levels and coagulopathy. Methodology: Management of acute liver failure includes: Assessment of prognosis for liver transplantation Prevention of complications while awaiting hepatic regeneration or liver transplantation. Hepatic support Many are the complications of acute liver failure. Management includes fluid restriction to 75% of maintenance using dextrose or high-calorie enteral nutrition. It is extremely important to maintain proper glucose levels. In the early stages of establishing the prognosis and requirements for liver transplantation, coagulation support is not recommended. If coagulation is severe (prothrombin time > 60”) and/ or the decision for liver transplantation has been made. Conclusion: Acute liver failure in pediatrics is rare but fatal disease. The development of effective supportive medical therapies and outcome of liver transplantation improve the prognosis, however also depends of the level of nursing care.