General aspects of the treatment of alcoholic hepatitis

Table 1 General approach to treatment of a patient with alcoholic hepatitis

Complication	Initial evaluation	Treatment	Treatment for refractory cases
Alcohol withdrawal	History of alcohol abuse Ethanol level	Fluid hydration Benzodiazepines Glucose supplementation Vitamin replacement	ICU placement IV benzodiazepines Propofol Phenobarbital Endotracheal intubation
Ascites	LFTs, ascetic fluid analysis, CT abdomen	Diuretics IV albumin Paracentesis	TIPS Liver transplantation
Altered mental status	CBC/BMP LFTs NCCT head Pancultures Lumbar puncture	IV antibiotics Lactulose Treat precipitant	Rifa × imin
Variceal bleeding	CBC LFTs	Blood transfusion octreotide Prophylactic antibiotics EVL	TIPS Shunt surgery for compensated cirrhosis
Infection	CBC/BMP Pancultures	Antibiotics for gram negative coverage	Broad spectrum antibiotics covering both gram positive and negative organisms
Malnutrition	Weight comparison Serum albumin	Oral supplementation	PEG placement Nutritionist consultation

CBC: Complete blood count; BMP: Basic metabolic panel; EVL: Endoscopic variceal ligation; TIPS: Transjugular intrahepatic portosystemic shunt.