Treatment
-Prevent and treat alcohol withdrawal.
-Alcohol abstinence
-Supportive Care:
–Fluid management and Nutritional support
–Monitor for infection
–Prophylaxis against gastric mucosal bleeding
–D/c nonselective beta-blockers in patients with severe alcoholic hepatitis. If beta-blockers are indicated, don’t start them until the patient has recovered.
-The severity of alcoholic hepatitis determined by using the Maddrey’s Discriminant Function for Alcoholic Hepatitis. On Mdcal.com.
-In patients with mild to moderate alcoholic hepatitis (Maddrey score <32), don’t treat with prednisolone or Pentoxyphilline.
-Maddrey scores above 32 indicate severe alcoholic hepatitis (which carries a poor prognosis). These patients would benefit from pharmacologic therapy plus supportive care rather than supportive care alone.
–Prednisolone 40 mg per day for 28 days, followed by a taper over two to four weeks.
-Pentoxyphilline: If there are contraindications to the use of glucocorticoids, pentoxifylline 400 mg three times per day for 28 days is an alternative. Once daily for 28 days in patients with a creatinine clearance <30 mL/minute).
-The Lille score (on MdCalc.com).
“The Lille Model risk stratifies patients already receiving steroids for alcoholic hepatitis treatment for 7 days to predict which will not improve and should be considered for other management strategies. All values besides 7-day bilirubin are taken from admission.”
Pearls
- **Prednisolone is preferred over prednisone because the latter requires conversion to prednisolone (the active form) in the liver, a process that may be impaired in alcoholic hepatitis.