Table 2.
Recommendations for Minimal Diagnostic Evaluation by Age in Pediatric Acute Liver Failure
| Recommended Tests | Indication | Recommended Age of Diagnostic Testing | |||
|---|---|---|---|---|---|
| Blood and Urine Tests | <3 mo. | 3 mo. to 3 yrs. | 3 mo. to 18yr. | 4 to 18 yr. | |
| Herpes blood PCR | Systemic Herpes infection | X | X | ||
| Serum amino acid profile | Urea cycle; other metabolic defects | X | X | ||
| Ferritin | GALD screen | X | |||
| Lactate, pyruvate | Mitochondrial screen | X | X | ||
| Plasma acylcarnitine profile | FAO defects | X | X | ||
| Urine succinylacetone | Tyrosinemia | X | |||
| Enterovirus blood PCR | Systemic Enterovirus infection | X | X | ||
| Acetaminophen level | Acetaminophen exposure | X | |||
| Hepatitis A virus IgM | Hepatitis A | X | |||
| Hepatitis B Surface antigen | Hepatitis B | X | |||
| EBV VCA IgM or PCR | EBV infection | X | |||
| Antinuclear antibody | Autoimmune disease screen | X | |||
| Anti-smooth muscle ab | Autoimmune disease screen | X | |||
| Liver kidney microsomal ab | Autoimmune disease screen | X | |||
| Immunoglobulin G | Autoimmune disease screen | X | |||
| Ceruloplasmin | Wilson disease screen | X | |||
| 24-hour Urine copper | Wilson disease screen | X | |||
| Historical Information | |||||
| Drug history | APAP other drug or HDS exposure | X | X | ||
| Confirm newborn screen results | Galactosemia and tyrosinemia | X | |||
| Confirm maternal Hepatitis B serology | Hepatitis B in newborn | X | |||
| Procedures | |||||
| Abdominal ultrasound with doppler | Vascular anomalies | X | X | ||
| Echocardiogram | Cardiac dysfunction | X | X | ||
| Optional Diagnostic screening | |||||
| Blood culture | Sepsis | ||||
| Viral testing for adenovirus, enterovirus, HHV-6, parvovirus, influenza | Viral infection | ||||
| Hepatitis E IgM | Hepatitis E | ||||
| Soluble IL2R, ferritin, triglyceride level | HLH | ||||
| Liver copper, Wilson gene mutation analysis | Wilson disease | ||||
| MRI for extrahepatic iron deposition | GALD | ||||
| Urine orotic acid | Urea cycle defects | ||||
Ab: antibody, APAP: acetaminophen, EBV: Epstein Barr Virus, FAO: fatty acid oxidation defects, GALD: gestational alloimmune liver disease, HHV-6: Human Herpes Virus-6, HLH: hemophagocytic lymphohistiocytosis, HDS: herbal, dietary supplement, IgM: immunoglobulin M, IL2R: interleukin 2 receptor, MRI: Magnetic resonance imaging, PCR: polymerase chain reaction, VCA: viral capsule antigen