Initial inpatient management for adults with severe alcohol-associated hepatitis

D5W: 5% dextrose; DF: Maddrey discriminant function; IV: intravenous; MELD: Model for End-stage Liver Disease.

* We administer N-acetylcysteine intravenously with a weight-based protocol for 5 days. Potentially serious adverse reactions to intravenous N-acetylcysteine include a nonallergic anaphylactic reaction with symptoms such as flushing, urticaria, angioedema, or hypotension. Patients receiving intravenous N-acetylcysteine warrant close monitoring, and all essential medications and equipment necessary to manage anaphylaxis should be available when the initial infusion is administered. Refer to content on dosing and adverse drug reactions for details.

¶ We typically do not begin glucocorticoids until the patient is afebrile, hemodynamically stable, and infection (if present) has been treated with antimicrobial therapy for 48 hours.

Δ The Lille score is a continuous score on a scale from 0 to 1, and a higher score indicates greater risk of mortality. The main driver of the Lille score is the change in bilirubin with treatment. Other variables are age, creatinine, albumin, and prothrombin time (or international normalized ratio). We typically calculate the Lille score on day 7. An alternative approach is to calculate the Lille score on day 4.