Notifiable if caused by agricultural chemicals and insecticides.
DESCRIPTION
Any form of hepatitis not caused by the common hepatotropic viruses.
Liver biopsy is indicated if hepatitis persists or diagnosis is unclear.
GENERAL MEASURES
Diet: restrict protein if features of liver failure are present. Excessive protein restriction may accentuate catabolism.
Avoid alcohol.
Avoid other hepatotoxic agents.
Monitor blood glucose regularly because hypoglycaemia is common.
MEDICINE TREATMENT
Hepatitis due to infections
Antibiotic therapy based on culture.
Alcohol-induced hepatitis
Even if no bleeding:
Vitamin K1, IM/IV, 5–10 mg daily for 10 days
Thiamine, oral, 100 mg daily
Other vitamins if indicated.
Drug-induced hepatitis
Stop all potentially hepatotoxic medication immediately.
Auto-immune hepatitis
Patients with hepatitis persisting with negative viral markers and no
hepatotoxins. Biopsy and autoimmune markers are necessary to make the diagnosis.
Prednisone, oral, 0.5–1 mg/kg daily
o Taper dose to a suitable maintenance dose.
PLUS
Azathioprine, oral, 0.5–1 mg/kg daily.
REFERRAL
» Where patients cannot be managed locally or biopsy cannot be done, i.e. diagnosis is unclear.
» Non-resolving hepatitis.
Refer timeously before extensive liver damage occurrs.
Reference and further reading
Standard Treatment Guidelines and Essential Medicines List for South Africa 2012 Edition
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