Vitamin KDose
<1 year 2.5 mg/dose od IV
>1 year 5 mg/dose od IV
>10 year 10 mg/dose od IV AntacidsRanitidine 1–3 mg/kg/dose tds IV
or
Omeprazole 0.5 mg/kg/dose bd IV or orally
Sucralphate 250–500 mg/dose qds (if gastric pH remains <5) Lactulose2–4 ml/kg/dose tds N-acetylcysteine150 mg/kg/day continuous infusion (only if paracetamol overdose) Broad-spectrum antibiotics:
Tazocin
Metronidazole90 mg/kg/dose tds
8 mg/kg/dose tds IV (bd for neonates up to 1 month) Antifungals:
Fluconazole
or
l-Amphotericin (Ambisome)3–6 mg/kg/day IV
Neonate under 2 weeks: 3–6 mg/kg on first day, then 3 mg/kg every 72 hours
Neonate 2–4 weeks: 3–6 mg/kg on first day, then 3 mg/kg every 48 hours
3 mg/kg/day IV Antiviral treatment:
Aciclovir
Must be started in all infants<3 months: 10 mg/kg tds IV
3 months–12 years: 250 mg/m² tds IV
>12 years: 5 mg/kg tds IV
NB: Double the dose in immunocompromised or severe illness

Prognosis

ALF secondary to hepatitis A, autoimmune hepatitis and paracetamol toxicity are most likely to recover with appropriate treatment.

See Chapter 31 for indications for transplantation in acute liver failure.

Children with grade III encephalopathy should be referred to intensive care. If children require an anaesthetic (such as for central line insertion), they may need PICU admission.

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