Version July 2025
| Recommended tests | Indication | <3 months | 3 months to 18 years |
| Blood and urine tests | |||
| 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 | Fatty acid oxidation defects | X | X |
| Urine succinylacetone | Tyrosinemia | X | |
| Enterovirus blood PCR | Systemic enterovirus infection | X | X (3 months to 3 years) |
| APAP level | APAP 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 antibody | Autoimmune disease screen | X | |
| Liver kidney microsomal antibody | Autoimmune disease screen | X | |
| IgG | Autoimmune disease screen | X | |
| Ceruloplasmin | Wilson disease screen | X (4 to 18 years) | |
| 24-hour urine copper | Wilson disease screen | X (4 to 18 years) | |
| Historical information | |||
| Drug history | Exposure to APAP, other drug, or herbal dietary supplement | 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 |
| Conditional 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 | Hemophagocytic lymphohistiocytosis | ||
| Liver copper, Wilson gene mutation analysis | Wilson disease | ||
| MRI for extrahepatic iron deposition | GALD | ||
| Urine orotic acid | Urea cycle defects | ||
APAP: acetaminophen; EBV: Epstein-Barr virus; GALD: gestational alloimmune liver disease; HHV-6: human herpesvirus 6; Ig: immunoglobulin; IL2R: interleukin-2 receptor; MRI: magnetic resonance imaging; PCR: polymerase chain reaction; VCA: viral capsid antigen.
* As of early 2022, adenovirus is under investigation as a possible cause of several clusters of acute hepatitis in young children. In such children, testing for adenovirus was suggested by the Centers for Disease Control and Prevention[1].
Original table modified for this publication. From: Narkewicz MR, Horslen S, Hardison RM, et al. A Learning Collaborative Approach Increases Specificity of Diagnosis of Acute Liver Failure in Pediatric Patients. Clin Gastroenterol Hepatol 2018; 16:1801. Table used with the permission of Elsevier Inc. All rights reserved.
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