K70.1/K71/K75.4
*Notifiable if caused by agricultural chemicals or 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: If no hepatic encephalopathy, then normal protein intake appropriate. With hepatic encephalopathy, maintain 1 to 1.5mg/kg daily protein intake.
Avoid alcohol and other hepatotoxic agents.
Monitor blood glucose regularly given potential risk of hypoglycaemia.
MEDICINE TREATMENT
If the patient is bleeding, check INR and correct coagulopathy with:
- Lyophilised plasma or FFP
Parenteral Vitamin K should be provided and the INR reassessed.
Hepatitis due to infections
Antibiotic therapy based on culture, serology or suspected aetiology e.g. leptospirosis.
Alcohol-induced hepatitis
- Thiamine, oral, 300 mg daily
Other vitamins if indicated.
Drug-induced hepatitis
Stop all potentially hepatotoxic medication immediately, in consultation with a specialist.
Auto-immune hepatitis K75.4
Patients with persistent hepatitis, negative viral markers and no hepatotoxins. Biopsy and/or various parameters are required to make the diagnosis.
If autoimmune hepatitis:
- Corticosteroids (intermediate-acting) e.g.:
- Prednisone, oral, 0.5 mg/kg daily.
- Taper dose to a suitable maintenance dose. (See PREDNISONE, ORAL for an example of dose reduction regimen)
AND (in consultation with gastroenterologist or hepatologist)
- Azathioprine, oral, 0.5 mg/kg daily, titrated up to 1 mg/kg daily depending on response and WCC.
REFERRAL
- Where patients cannot be managed locally or biopsy cannot be done, i.e. diagnosis is unclear.
- Non-resolving hepatitis.
Note: Refer timeously before extensive liver damage occurs.