Acute liver failure in children - A constant challenge for the treating intensivist

Pediatric acute liver failure (ALF) is a rare complex clinical syndrome with a fatal outcome, if not diagnosed and treated at the right time. ALF in children can be difficult to recognize and is very different from ALF in adults; in terms of definition, etiology, symptomatology and management. The causes of ALF in children represent a large heterogeneous list, which vary by age and geographical location. The management of ALF mandates multidisciplinary approach with comprehensive intensive and supportive care; which at times is complex and can be challenging to a pediatric intensivist. The key steps in management are to monitor and support affected organ systems; anticipate, identify and treat complications; and maintain optimal clinical condition till spontaneous recovery or liver transplantation. This review describes definitions, etiopathogenesis, clinical features and the most recent management strategies, including emergency liver transplantation considerations in pediatric ALF.