Pathogenesis and Treatment of Severe Hepatitis, January 6, 1994

Pathogenesis and Treatment of Severe Hepatitis, January 6, 1994

The pathogenic effect of the hepatitis B virus itself is limited; the occurrence of severe cases is related to the body’s immune response. Recently, it has been discovered that among hepatitis B patients co-infected with eight factors, 30% develop fulminant infections, with chronic carriers who are HBcIgM negative having an even higher incidence of fulminant liver failure, highlighting the dangers of these eight factors. Other contributing factors include specific immune responses and impaired immune regulatory functions. Non-immune factors include endotoxemia and microcirculatory disorders. Treatment principles are as follows: rest—bed rest, emotional support, and confidence-building. Treatment—low-fat, low-salt, low-protein, high-sugar, semi-liquid, and liquid diets.

1. Glucagon and insulin therapy: 500 mL of 10% glucose solution plus 1 mg of glucagon and 10 units of insulin, administered intravenously once or twice daily.

2. Compound branched-chain amino acids: 250 mL of six-branched amino acids mixed with 250 mL of 10% glucose solution, administered intravenously once or twice daily.

3. Potassium magnesium aspartate: 20 mL of 10% potassium magnesium aspartate mixed with 250 mL of 10% glucose solution, administered intravenously once or twice daily.

4. Symptomatic support with vitamins E, B, K3, albumin, whole blood, etc., as well as hepatitis spirit 2 mL, administered intramuscularly once or twice daily.

5. For patients with gastric and esophageal variceal bleeding, use cimetidine 200 mg, taken orally three times daily. 0.5% norepinephrine, aluminum hydroxide gel, and magnesium milk (1:5:4), taken orally twice daily. Propranolol 10 mg, taken orally three times daily. Pituitary posterior lobe extract 10 U mixed with 250 mL of 10% glucose solution, administered intravenously once or twice daily. In cases of massive bleeding, a three-lumen tube can be used for compression hemostasis.

6. For hepatic coma: acetylglutamine 1 g mixed with 250 mL of 10% glucose solution, administered intravenously once or twice daily. Vinegar enema: 50 mL of vinegar mixed with 150 mL of saline, administered once or twice daily.

7. Traditional Chinese medicine treatment.

8. Antibiotic use, divided into intestinal and systemic applications. For intestinal use, neomycin 1 g can be taken orally every four hours; for systemic use, Pioneer II or metronidazole can be used.

9. If hepatic coma continues to worsen, pulmonary edema and cerebral edema may occur. In such cases, 20% mannitol 250 mL can be administered rapidly via intravenous drip, with the infusion completed in about half an hour.