Fulminant Hepatic Failure

Fulminant hepatic failure (FHF), also called acute liver failure, is defined as severe liver failure (including encephalopathy or decreased brain function) that occurs within six weeks of onset of jaundice (yellowing of the skin and whites of the eyes). The term is used to describe sudden liver failure in someone who was previously healthy.

FHF may be due to a virus. The immune system of an infant, a young child or a child with other health problems may not be able to fight the virus. The liver becomes damaged as a result. Other children may experience acute liver failure because of an overactive immune system (an autoimmune response where the body attacks the liver), a drug reaction or other unspecified causes. Often, the cause of FHF cannot be determined.

Early symptoms of FHF include:

Abdominal fluid buildup and swelling (ascites)
Abdominal pain
Dark urine
Fatigue
Fever
Itching
Jaundice
Loss of appetite
Nausea
Pale stool
Tendency to bruise or bleed easily

As liver failure progresses:

Toxins build up in the body and may cause confusion, erratic behavior and brain swelling (brain swelling can be life-threatening)
The child may become comatose
The liver cannot make clotting factors, resulting in bleeding that can be life-threatening
The liver cannot get rid of bilirubin which causes severe jaundice
Acute kidney failure may occur

Diagnosis of Fulminant Hepatic Failure

If your child experiences symptoms of FHF, a pediatric gastroenterologist will use the following exams and tests to confirm liver failure and determine the cause:

Blood tests
Urinalysis
Ultrasound
Liver biopsy

Treatments

Treatment for children with FHF requires intensive care unit (ICU) support in the hospital and includes:

IV fluids. Your child will receive IV fluids to balance electrolytes and glucose levels.
Blood transfusions. If the liver and kidneys are not working properly, a blood transfusion provides healthy blood.
Hemodialysis. If the kidneys fail, hemodialysis can help clean the blood.
Respiratory assistance. Children who are comatose may need a tube placed in the throat (intubation) to help with breathing.
Liver transplant. In some cases, the best chance for recovery is a liver transplant.

Key Points to Remember

FHF is also called acute liver failure.
The term "fulminant" is used to describe sudden liver failure in someone who was previously healthy.
FHF is severe liver failure that happens within six weeks of the onset of jaundice.
FHF may be caused by a virus.
Often, the cause of FHF cannot be determined.

Support Services & Resources

Visit the websites below to find support groups and services and learn more about FHF.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

Riley at IU Health Liver Support Group

The Riley at IU Health Liver Support Group meets one or two times a year for a family-oriented education program and socializing. Please call 317.944.3774 for meeting dates and times. Topics include testing for liver disease, complications of liver disease, impact of chronic disease on the family, liver transplant, nutrition for liver disease and medicine for liver disease.

American Liver Foundation

This website provides education and support resources for children and families living with FHF.

Fulminant Hepatic Failure Research

Riley at IU Health is part of the Childhood Liver Disease Research Network, an international research collaboration that looks for new and better ways to treat childhood liver diseases. Through this research network, your child may be eligible to participate in a clinical study which will help improve treatment for childhood liver conditions. Ask your child's doctor for more information about current participatory research studies.

Locations

In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.