Last reviewed: November 2017
Last updated: September  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • vomiting
  • altered mental status

Other diagnostic factors

  • hyperventilation
  • hepatomegaly
  • abnormal pupillary response
  • hyper-reflexia/areflexia
  • diminished pain response
  • seizures
  • absence of, or minimal, jaundice and scleral icterus

Risk factors

  • age 5-14 years
  • white ethnicity
  • recent viral infection
  • aspirin (acetylsalicylic acid) and other drug exposure
  • genetically predisposed individual
  • toxin exposure
  • winter/spring presentation

Diagnostic investigations

1st investigations to order

  • serum electrolytes
  • serum glucose
  • LFTs
  • serum ammonia
  • PT/PTT
  • urine/serum toxicology
  • urinalysis
  • blood gas
Full details

Investigations to consider

  • cranial CT
  • LP with CSF analysis
  • EEG
  • liver biopsy
  • metabolic testing
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Section Head of Pediatric Hospital Medicine

Ochsner Medical Center for Children

New Orleans

LA

Disclosures

VGC declares that she has no competing interests.

Section Head of Pediatric Infectious Diseases

Ochsner Medical Center for Children

New Orleans

LA

Disclosures

RWS declares that he has no competing interests.

Dr Vanessa G. Carroll and Dr Russell W. Steele would like to gratefully acknowledge Dr Barry M. Starr, a previous contributor to this monograph. BMS declares that he has no competing interests.

Peer reviewers VIEW ALL

Professor of Pediatrics

Cincinnati Children's Hospital Medical Center

Cincinnati

OH

Disclosures

WFB declares that he has no competing interests.

Consultant Histopathologist

Institute of Liver Studies

King's College Hospital

London

UK

Disclosures

BP declares that he has no competing interests.

Use of this content is subject to our disclaimer