PE23.13 | Acute Hepatitis — Summary & Reflection

KEY TAKEAWAYS

Acute hepatitis in children is most commonly caused by Hepatitis A virus (HAV) in India — faeco-oral route, IgM anti-HAV = acute infection marker, self-limiting, no chronic sequelae. Hepatitis E (faeco-oral, outbreaks, water-borne) is similar in children but carries very high mortality in pregnant women. Hepatitis B (blood and vertical transmission) can cause acute hepatitis but more commonly establishes chronic infection in perinatal/early childhood acquisition. Acute Liver Failure (ALF) = encephalopathy + INR >1.5 + within 8 weeks — this is a medical emergency requiring PICU/liver transplant centre referral. Key serology: IgM anti-HAV = acute HAV; HBsAg + IgM anti-HBc = acute HBV; anti-HBs = immunity. Paracetamol overdose = ALF, treat with N-acetylcysteine within 8–10 hours. Management of uncomplicated viral hepatitis is supportive (rest, hydration, nutrition, avoid hepatotoxins). Prevention: HAV vaccine (2 doses, IAP-recommended); HBV vaccine in NIS (birth dose + pentavalent series).

REFLECT

The child in the hook is likely to recover completely. But consider for a moment the scenario where his INR was 2.8 and he was confused. The management of ALF in a district hospital with no liver transplant capacity involves making one of the most difficult decisions in paediatrics: when to transfer, how quickly, and to whom. In a resource-limited setting, who do you call? How do you communicate the urgency without causing panic? Reflect on how your clinical reasoning about 'routine jaundice' changes the moment you see INR >1.5 and a change in mental status — and what systems you need in place in your future practice to ensure that this transition from outpatient to emergency is never missed.