Managing Patient with Alcoholic Hepatitis

 

Patient selection: hospital admission for alcoholic hepatitis

 

Criteria for high risk – any of the following:

(1) modified Maddrey discriminant function >= 32 (see 11.07.05)

(2) presence of hepatic encephalopathy

(3) MELD score >= 18

 

Criteria for low risk:

(1) modified Maddrey discriminant function < 32 AND decrease in serum total bilirubin during first week in hospital

(2) MELD score < 18 AND MELD score decrease during first week in hospital by >= 2 points

 

If the patient is high risk and the diagnosis is uncertain then consider performing a liver biopsy.

 

All patients should undergo:

(1) a nutritional assessment and intervention.

(2) abstinence counseling

(3) evaluation and management of comorbid conditions

High Risk Patient	Drug Therapy
early renal failure OR corticosteroids contraindicated	pentoxifylline (400 mg po tid for 4 weeks)
normal renal function AND corticosteroids not contraindicated	prednisolone 40 mg/day for 28 days with or without 2 week taper