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Dr. Robert Squires reviews the history, diagnosis, and studies for acute liver failure in children.

Educational objectives:

Upon completion of this activity, participants should be able to:

  • Recognize that hepatic encephalopathy is not a required to establish a diagnosis of acute liver failure in children.
  • Recognize the results of the randomized trial of N-acetylcysteine (NAC) in children with acute liver failure not caused by acetaminophen.
  • Recognize that the liver is an immunological solid organ

Reading Resources:

  1. Squires RH, Shneider BL, Bucuvalas J, Alonso E, Sokol RJ, Narkewicz MR, Dhawan A, Rosenthal P, Rodriguez-Baez N, Murray KF, Horslen S, Martin MG, Lopez MJ, Soriano H, McGuire BM, Jonas MM, Yazigi N, Shepherd RW, Schwarz K, Lobritto S, Thomas DW, Lavine JE, Karpen S, Ng V, Kelly D, Simonds N, Hynan LS.  Acute Liver Failure in Children: The First 348 Patients in the Pediatric Acute Liver Failure Study Group.  J. Pediatr. 2006;148:52-658  PMCID:PMC2662127
  2. Squires RH.  Acute Liver Failure in Children.  Seminars in Liver Disease.  2008;28:153-166.
  3. Narkewicz MR, Dell-Olio D, Karpen SJ, Murray KF, Schwarz K, Yazigi N, Zhang S, Belle SH, Squires RH.  Pattern of diagnostic evaluation for the causes of pediatric acute liver failure.  J Pediatrics 2009; 155:801-806.  PMID: 19643443 PMCID: N/A
  4. Sundaram SS, Alonso EM, Narkewicz M, Zhang S, Squires R, and the PALF Study Group. Characterization and outcomes of young infants with acute liver failure. J Pediatr 2011;159(5):813-18.  PMCID: PMC3177978
  5. Squires RH, Dhawan A, Alonso E, Narkewicz MR, Shneider BL, Rodriguez-Baez N, Dell Olio D, Karpen S, Bucuvalas J, Lobritto S, Rand R, Rosenthal P, Horslen S, Ng V, Subbaro G, Kerkar N, Rudnick D, Lopez MJ, Schwarz K, Romero R, Elisofon S, Doo E, Robuck PR, Lawlor S, Belle SH for the Pediatric Acute Liver Failure Study Group.  Intravenous N-acetylcysteine in pediatric patients with non-acetaminophen acute liver failure: A placebo-controlled trial.  Hepatology. 2013:57;1542-49.  (PMC3509266)
  6. Azhar N, Ziraldo C, Barclay D, Rudnick D, Squires RH, Vodovotz Y for the Pediatric Acute Liver Failure Study Group.  Analysis of serum inflammatory mediators identifies unique dynamic networks associated with death and spontaneous survival in pediatric acute liver failure. PLOS ONE. 2013;8(11):e78202. (PMC3823926)
  7. Li R, Belle SH, Horslen S, Chen LW, Zhang S, Squires RH.  Clinical course among pediatric cases of acute liver failure of indeterminate diagnosis. J Pediatr 2016;171:163-170. (PMC 4808594)


Dr. Squires has reported no relevant relationships with any entities producing health care goods or services.

All presenters disclosure of relevant financial relationships with any any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .75 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.075) continuing education units (CEU) which are equivalent to .75 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 6/21/2016 | Last Modified On: 6/21/2016 | Expires: 6/21/2017

This course has been expired.