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Nurse helping a Child with PALF and her family (PEDSALF.com)

WHAT IS SUPPORTIVE CARE FOR A PATIENT
WITH ACUTE LIVER FAILURE?

The liver has a wide range of important functions that are vital to the lungs, heart, kidney and brain. As the liver fails it can affect these organs, especially the brain. Supportive care measures protect the other organs and support their ongoing function while the liver tries to heal. Clinical experience and previous research studies have helped doctors caring for liver failure determine the best ways to provide this support. Below is a brief description of valuable supportive therapies.

Top of Supportive Care

Your care team will include a group of doctors and nurses that are experienced in the care of acute liver failure and who integrate care and communication among a group of specialists that focus on all aspects to support your child. Your center is part of a large network that focuses on treatments in PALF and are nationally recognized experts in the care of liver failure and children with complex illness.

Team Based Care

Energy metabolism is impaired in acute liver failure which can lead to critically low blood sugar levels. Having a central or long IV line that extends deep into the venous system allows your child to receive a higher concentration of glucose than what can be used in a shorter IV. This ensures that this source of glucose is not interrupted while the liver is
struggling to process energy sources and prevents your child from developing low blood sugar levels. Your child will also require frequent blood laboratory monitoring. Central line placement can help reduce the number of times your child must be stuck with a needle to obtain a blood sample.

Central IV access

Fever is a natural part of the body’s defensive response to injury, but fever can place additional stress on the brain and increase the risk for brain injury. Your child’s temperature will be monitored and they may be treated with interventions to decrease their temperature if they develop a fever.

Management of fever

As liver cells are dying, they release toxins into the blood stream that can suppress heart function and cause lower than normal blood pressure. Lower than normal blood pressure can increase the risk for kidney and brain injury. Children with liver failure are monitored closely to determine if they need medications to strengthen the heart’s pumping ability or help maintain normal blood vessel tone and regulate blood pressure throughout the body.

Medications to support blood pressure

Children who are not fully awake may need to be placed on oxygen and possibly a breathing machine to ensure that their lungs continue to function properly and to prevent fluid from accumulating in their lungs. As PALF advances, some children do accumulate fluid in their lungs and breathing support on a ventilator can help decrease that fluid
accumulation and improve the oxygen content in their blood.

Breathing support

The liver synthesizes and regulates important proteins that allow blood to clot when necessary. All children with PALF have abnormal coagulation and some may develop serious bleeding in their lungs or in their stomach or intestines. If your child has serious bleeding, they may be treated with blood products such as red blood cells, platelets or plasma to help stop this bleeding.

Blood and plasma transfusions

Dialysis is required when kidney function is reduced which is common in advancing acute liver failure. Both dialysis and plasma exchange are also being used more commonly to remove toxins normally released by the injured liver which contribute to progressive organ failure. The decision to use dialysis or plasma exchange is individualized to the needs of each child with PALF and not all children will receive these therapies. Plasma
exchange uses plasma from blood donors to replace some of your child’s plasma. This exchange process is called plasmapheresis and helps to eliminate ammonia, other toxins, and inflammatory proteins from the circulation. This process also replaces coagulation factors in a balanced way that may help re-establish normal blood clotting.

Dialysis and Plasma exchange

It is also very important to monitor the brain to determine if your child is developing hepatic encephalopathy. Progression of hepatic encephalopathy is one of the most important signs doctors use to determine if your child is likely to require a liver transplant to survive. Brain injury is common in PALF and when the injury is severe it can cause brain
swelling. The ICU team will monitor your child closely for signs of brain injury and swelling and can use a variety of medication to protect the brain while patients are awaiting liver transplantation.

Protecting the Brain

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