Gastrointestinal

Acute Hepatitis

یرقان

Fever, jaundice and vomiting with right hypochondrial tenderness. Supportive care with IV dextrose, L-ornithine L-aspartate, antipyretic and antiemetic.

ICD-10: —
Source: OPD handbook pp.58–61
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Fever
Jaundice (eyes turned yellow)
Vomiting

Diagnosis

General physical examination: jaundice positive
Right hypochondrial tenderness positive
Advice LFTs

Treatment

Step 1 of 3

1. Adults

Pass an IV line

Prescription

5% Dextrose in water (D/W) IVIV fluid

Dose1 litre IV

Brand Inj 5% D/W

L-Ornithine L-AspartateHepatic supportive

Dose2 ampoules in IV fluid

Brand Inj Hepamerz / Levinjon

Also sold as Hepamerz, Levinjon

MetoclopramideProkinetic / antiemetic

Dosein IV fluid

Brand Inj Maxolone

Also sold as Maxolone, Maxolon, Metaclon, Metomide

Paracetamol (Acetaminophen)Analgesic / antipyretic

DoseSOS (2 tabs as needed)

Brand Panadol

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

IbuprofenNSAID

Doseone tablet SOS if fever

Brand Brufen 400 mg

Caution: Avoid in dengue (bleeding risk); Avoid in kidney disease, peptic ulcer, late pregnancy; Take with food

DomperidoneProkinetic / antiemetic

Dose1+1+1 if vomiting (SOS)

Brand Motilium / Stomacol 10 mg

Also sold as Stomacol, Motilium, Peridone

Step 2 of 3

2. Paediatrics

Prescription

L-Ornithine L-AspartateHepatic supportive

Dose2+2+2 teaspoons

Brand Syp Hepamerz / Levinjon

Also sold as Hepamerz, Levinjon

IbuprofenNSAID

Dose½ teaspoon as needed (SOS)

Brand Syp Brufen 100 mg/5 mL

Caution: Avoid in dengue (bleeding risk); Avoid in kidney disease, peptic ulcer, late pregnancy; Take with food

Paracetamol (Acetaminophen)Analgesic / antipyretic

DoseSOS

Brand Syp Panadol

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

DomperidoneProkinetic / antiemetic

Dose1+1+1 teaspoon

Brand Syp Motilium 5 mg/5 mL

Also sold as Stomacol, Motilium, Peridone

Step 3 of 3

3. Diet and counselling

Use clean water
Take care of hand hygiene
Take fruit juices and vegetables
Per the Urdu notes: stop roti, rice and meat; avoid oily things; khichdi and sago (sabudana) can be eaten

Sample prescriptions from the book (patient details removed)

Child/adult, fever and vomiting for 2 days, jaundice positive: Syp Hepamerz 2+2+2 tsp; Syp Brufen 100 mg/5 mL ½ tsp as needed; Syp Motilium 1+1+1 tsp; stop roti, take fruits; khichdi and sago can be eaten.
Male, 20 y, fever and vomiting for 2 days, jaundice positive, mild tenderness right hypochondrium: Plan: IV line; Inj 5% D/W 1 litre IV; Inj Hepamerz × 2 ampoules in IV fluid; Inj Maxolone in IV fluid; Tab Brufen 400 mg as needed; Tab Motilium 10 mg 1+1+1 if vomiting; clean water, hand hygiene, fruit juices and vegetables; stop oily food, roti, rice and meat.
Male, 30 y, fever, yellow colouration of urine, jaundice positive: Inj Hepamerz 2 ampoules in 1 litre 5% D/W; Tab Stomacol if vomiting; Tab Panadol 2 tabs as needed; advised LFTs.