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©2013 UpToDate ® Print Email Age-specific diagnostic priorities for children with acute liver failure <3 months of age Herpes blood PCR (or other testing: HSV IgM, viral culture of blood or CSF, CSF PCR) Enterovirus blood PCR (or other testing) Lactate, pyruvate (mitochondrial screen) Plasma acylcarnitine profile (fatty acid oxidation defects) Ferritin (screen for gestational alloimmune liver disease [neonatal hemachromatosis]) Serum amino acid profile (urea cycle and metabolic) Echocardiogram: Cardiac dysfunction Abdominal ultrasound with Doppler (vascular and anatomic) Confirm newborn screening results (galactosemia and tyrosinemia) Confirm maternal hepatitis B serology 3 months to 4 years HBsAg, HAV IgM, EBV VCA IgM or EBV PCR Lactate, pyruvate (mitochondrial screen) Autoimmune markers: ANA, ASMA, ALKM, IgG Drug history, acetaminophen level Plasma acylcarnitine profile (fatty acid oxidation defects) Serum amino acids Abdominal ultrasound with Doppler (vascular and anatomic) 5 years to 18 years HBsAg, HAV IgM, EBV (EBV VCA IgM or PCR) Autoimmune markers: ANA, ASMA, ALKM, IgG Ceruloplasmin Drug history, acetaminophen level Lactate, pyruvate (screen for mitochondrial disorders) Plasma acylcarnitine profile (Fatty acid oxidation defects) Serum amino acids Abdominal ultrasound with Doppler (vascular and anatomic) Additional diagnostic screening tests to consider, directed by history and clinical course Infectious causes Blood culture Viral PCR in blood for adenovirus, enterovirus, EBV, HHV-6, parvovirus Nasal wash for influenza (infections) Hepatitis E antibody Serologic tests for celiac disease (eg, tissue transglutaminase) Soluble IL2R, ferritin in older patients, triglycerides (hemophagocytic lymphohistiocytosis) Echocardiogram (cardiac) MRI for tissue iron (gestational alloimmune liver disease [neonatal hemochromatosis]) Urine succinyl acetone (tyrosinemia) Urine orotic acid (urea cycle defects) Urine organic acids (metabolic) Liver copper, Wilson gene mutation analysis (Wilson) Liver biopsy for histology, culture, electron microscopy PCR: polymerase chain reaction; HSV: herpes simplex virus; IgM: immunoglobulin M; CSF: cerebrospinal fluid; HBsAg: hepatitis B s antigen; HAV: hepatitis A virus; EBV: Epstein-Barr virus; VCA: viral capsid antigen; ANA: anti-nuclear antibodies; ASMA: anti-smooth muscle antibodies; ALKM: anti-liver-kidney microsomal antibodies; HHV-6: human herpes virus 6; IL2R: interleukin 2 receptor. MRI: magnetic resonance imaging.
PCR: polymerase chain reaction; HSV: herpes simplex virus; IgM: immunoglobulin M; CSF: cerebrospinal fluid; HBsAg: hepatitis B s antigen; HAV: hepatitis A virus; EBV: Epstein-Barr virus; VCA: viral capsid antigen; ANA: anti-nuclear antibodies; ASMA: anti-smooth muscle antibodies; ALKM: anti-liver-kidney microsomal antibodies; HHV-6: human herpes virus 6; IL2R: interleukin 2 receptor. MRI: magnetic resonance imaging. Modified with permission from: Squires RH, Alonso EM. Acute liver failure in children. In: Liver Disease in Children, 4th ed, Suchy FJ, Sokol RJ, Balistreri WF (Eds), Cambridge University Press, New York 2012. Copyright © 2012 Cambridge University Press.