The current pediatric perspective on type B and C hepatic encephalopathy
Valérie A McLin1, Lorenzo D'Antiga2
1Swiss Pediatric Liver Center, Division of Pediatric Specialties, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals Geneva and University of Geneva, Geneva, Switzerland.
Analytical Biochemistry
|February 1, 2022
Summary
Hepatic encephalopathy (HE) in acute liver failure (ALF) is known, but its impact on children with chronic liver disease (CLD) is less understood. This review focuses on the unique neurocognitive effects in children due to ongoing brain development during liver disease.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Pediatric Neurology
- Neurodevelopmental Disorders
Background:
- Hepatic encephalopathy (HE) is a recognized complication in pediatric acute liver failure (ALF), impacting survival.
- The neurocognitive and psychiatric effects of chronic liver disease (CLD) in children are less understood, with limited data extrapolated from adult studies or animal models.
- Children's developing brains face unique risks from liver disease due to ongoing central nervous system growth.
Purpose of the Study:
- To review the distinctive neurocognitive aspects in children with CLD.
- To highlight the unique challenges and outcomes related to neurodevelopment in pediatric chronic liver disease.
- To synthesize current understanding of neurocognitive impacts in children with CLD or portosystemic shunts.
Main Methods:
- Literature review focusing on neurocognitive and psychiatric outcomes in pediatric CLD.
- Analysis of studies examining children with established CLD or those who have undergone portosystemic bypass.
- Synthesis of findings considering the developmental stage of the pediatric brain.
Main Results:
- Children with CLD exhibit distinct neurocognitive profiles compared to adults.
- Ongoing brain development in children with liver disease presents unique vulnerabilities.
- Limited research exists specifically on the long-term neurocognitive sequelae in pediatric CLD.
Conclusions:
- The neurocognitive impact of CLD in children requires further dedicated research.
- Understanding these unique risks is crucial for improving long-term outcomes in pediatric liver disease.
- Pediatric-specific research is needed to address the neurodevelopmental consequences of CLD.
Related Concept Videos
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
17
In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
17
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
10
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
10
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
11
Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
11
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
10
Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
10
01:08Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
8
Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
8
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
6
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
6