Rushda Aftab, Imran Iqbal.
Fulminant hepatic failure in children clinical features, etiology and outcome analysis.
Pak Paed J Jan ;31(4):195-200.

Objective: To study clinical features, etiology and indicators of poor outcome in children with fulminant hepatic failure. Study Design: Descriptive observational study. Place &Duration of Study: Pediatric Medicine Unit II Nishtar Hospital Multan from November 2003 to April 2006. Patients and Methods: Sixty three patients with fulminant hepatic failure were included in this study. The age limit was six months to twelve years. Their clinical features were noted. Routine laboratory investigations were done. Blood samples were sent for viral markers (A, B &C). Clinical &laboratory features were correlated with outcome. Results: Out of 63 patients with FHF 45(71.4%) were male and 18(28.6%) were female and mean age of presentation was 6 years. Forty five (71%) children had hyper-acute liver failure, 14(22%) acute and 4 (6%) sub-acute liver failure. Twenty (31%) children presented with Grade I-II encephalopathy and 43(68%) were in Grade III-IV encephalopathy. Thirty five (55.6%) children had hematemesis or malena at presentation and ascites was present in 8(12.7%) patients. Viral markers were positive in 40(63%) patients: HBV in 35(55%) HAV in 3(4.8%), and co-infection was present in 2(3.2%) patients. Enteric fever was present in 2(3.2%) patients and one (1.6%) patient was taking anti-tuberculous treatment. Overall mortality was (38/63) 60%. Poor outcome was associated with high grade of encephalopathy, hematemesis at presentation, hypoglycemia, serum bilirubin >10mg/dl, prothrombin time > 50Sec, SGPT > 1000IU and hemoglobin < 10gm/dl. Conclusion: Fulminant hepatic failure is potentially a fatal disease. Viral hepatitis is the most common cause of hepatic failure which is preventable with immunization.

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