Patient handout

Severe Alcoholic Hepatitis

PRODUCTION

1. Your condition

This handout is for severe alcoholic hepatitis. Your care team identified this based on: new jaundice (within 8 weeks) + active heavy alcohol use (aasld ald 2019).

Other reasons your team may use this plan: fever, anorexia, tender hepatomegaly in heavy drinker (aasld ald 2019); ast/alt >1.5:1 with both <500 u/l + bilirubin >3 mg/dl in active drinker (aasld ald 2019); heavy alcohol use (women >3 drinks/day or 7/wk; men >4 drinks/day or 14/wk) for >=6 months with active use within 60 days (aasld ald 2019).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
thiamine	100-500 mg IV daily x 3-5d then 100 mg PO daily	IV/PO	daily	Wernicke prophylaxis BEFORE dextrose; standard in AUD (AASLD ALD 2019)
folic_acid	1 mg PO/IV daily	PO/IV	daily	Megaloblastic anemia prevention
lorazepam	1-2 mg IV/PO q4-6h prn CIWA >=10	IV/PO	CIWA-triggered	AWS management; lorazepam preferred over oxazepam/diazepam in liver failure (less hepatic clearance dependence) but use minimum needed to avoid HE precipitant (AASLD ALD 2019)

Plan: Severe alcoholic hepatitis - prednisolone with Lille day-7 gating + NAC adjunct + transplant for non-responders (AASLD ALD 2019; STOPAH 2015; Mathurin 2011)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Maddrey discriminant function >=32 ( 4.6 x (PT - control PT) + total bilirubin mg/dL ) (Maddrey 1978)
MELD >=21 alternative severity threshold for AH (Crabb 2020)
Lille score >=0.45 at day 7 of prednisolone = non-responder; ~75% 6-month mortality on continued steroids (Louvet 2007)(life-threatening)
Bacterial or fungal infection diagnosed during prednisolone course (STOPAH 13% on pred vs 7% off)
HRS-AKI per ICA criteria in severe AH (Crabb 2020)(life-threatening)
Ascitic PMN >=250/mm^3 in AH (AASLD ALD 2019)
CIWA >=15 or seizure or DT in AH patient (AASLD ALD 2019)

5. Follow-up

Alcohol cessation programs (CBT, MAT - acamprosate/naltrexone/baclofen), nutrition, q1-3mo hepatology + addiction, vaccinations (HAV/HBV/influenza/pneumococcal), HCC surveillance if cirrhotic, transplant follow-up if listed (AASLD ALD 2019)

6. Sources

Guideline: AASLD 2019 Practice Guidance: Diagnosis and Treatment of Alcohol-Associated Liver Diseases (Crabb, Hepatology 2020)