Emergency Treatment of Severe Hepatitis, July 15, 2003

Emergency Treatment of Severe Hepatitis, July 15, 2003

The hallmark of this disease is “three highs, three lows, and two edemas.” The “three highs” refer to elevated blood ammonia, increased pseudo-neurotransmitters (hydroxyphenylethanolamine), and elevated aromatic amino acids. The “three lows” refer to low blood potassium, low serum albumin, and low blood sugar. The “two edemas” refer to pulmonary and cerebral edema.

1. Elevated blood ammonia can lead to hepatic encephalopathy, or liver coma. The most commonly used medications include glutamic acid, arginine, acetylglutamylamine, yabosi, and potassium magnesium aspartate.

2. Increased pseudo-neurotransmitters mean increased hydroxyphenylethanolamine. This substance has the same structure as dopamine and can replace dopamine in brain tissue, resulting in a dopamine deficiency and exacerbating hepatic encephalopathy. Treatment aims to replenish dopamine, but pure dopamine cannot cross the blood-brain barrier directly; it must be administered in the form of levodopa. However, levodopa can easily damage the liver, so it must be co-administered with carbidopa to avoid liver injury. Typically, 100 mg of levodopa and 20 mg of carbidopa are added to 250 mL of 10% glucose for intravenous infusion.

3. Increased aromatic amino acids are addressed by intravenous infusion of six amino acids, increasing the proportion of branched-chain amino acids. For the “three lows,” potassium, sugar, and albumin should be supplemented as needed. In addition, infection and bleeding should be controlled to slow the progression of hepatorenal syndrome.