Hepatitis, Non-Viral

Description

General Measures

Medicine Treatment

Referral

---

ICD-10 code: K70.1/K71.0-9/K73.0-2/K73.8-9/K75.4

*Notifiable medical condition 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 jaundiced with a prolonged INR (INR>2)

• Vitamin K1, IV, 10 mg
  • Administer as a slow IV injection.
  • Do not dilute or mix with other injectables.

LoE:IVb

If the patient is bleeding, give

• Lyophilised plasma, IV, 15mL/kg over 20-30 minutes.

OR

• Fresh Frozen Plasma, IV, 15mL/kg over 20-30 minutes.

AND

Discuss further management with a specialist.

LoE:IIb^xv

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

ICD-10 code: 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. (Refer to Appendix II for an example of a 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.

---

Click here for the pdf.

Click here for the NEMLC Recommendations for medicine treatement (2020-4 review cycle).

---

Standard Treatment Guidelines And Essential Medicines List For South Africa, Adult Hospital level, 2020-4_Version 1_July 2024

Chapter 1: Alimentary tract; 1.2 Hepatic Disorders; 1.2.1 Hepatitis, Non-Viral