Dawaa Reference

infectious

Acute Viral Hepatitis A

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

MSF Essential Drugs 2024 - paracetamol (oral) · WHO Hepatitis A Position Paper 2022 · WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: WHO; 2005 · WHO/UNICEF reduced-osmolarity oral rehydration salts (245 mOsm/L), recommended since 2002

Verified against2 documents
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: WHO; 2005

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (12)

  • It may cause nothing at all, or an illness with jaundice, dark urine and pale stools [jaundice · pale stools]
  • Onset is acute, about 28 days after exposure on average, with a range of 15 to 50 days
  • Prodrome of malaise, vomiting, poor appetite, fever and right upper quadrant pain [abdominal pain · fever · malaise · poor appetite · right upper quadrant pain · vomiting]
  • About a week later a heavier phase brings fever, malaise, no appetite, nausea, abdominal discomfort and jaundice, lasting a median of 8 weeks [abdominal pain · fever · jaundice · malaise · nausea]
  • Jaundice appears in 40% to 80% and dark urine in 68% to 94%, with tiredness in 52% to 91% and appetite loss in 42% to 90% [fatigue · jaundice · poor appetite]
  • A third have abdominal pain at some stage, and half describe cholestatic features including pale stools [abdominal pain · pale stools]
  • Children under 6 are usually silent or mildly affected; older children and adults are jaundiced in more than 70% of cases
  • The illness settles within 2 months, most often in about 2 weeks
  • Infectivity peaks in the fortnight before symptoms and lasts at least a week after they start
  • Up to 10% relapse within 6 months, usually milder, lasting under 3 weeks clinically though enzymes may stay up for a year [relapse]
  • Red flag: bleeding tendency and clouded consciousness after the jaundice appears mean acute liver failure [bleeding tendency · jaundice]
  • In pregnancy it carries a higher risk of preterm labour and other complications

Signs — what you find (7)

  • Examination shows yellow sclerae and a tender enlarged liver [hepatomegaly · jaundice]
  • In the cholestatic phase there may be scratch marks and shiny nails
  • A small self-limiting pleural effusion can occur but is not usually detectable at the bedside
  • Rarely an enlarged spleen, a rash, enlarged nodes or arthritis appear outside the liver [lymphadenopathy · rash · splenomegaly]
  • Stay alert for encephalopathy and for signs of a clotting failure, rare but serious
  • Bradycardia, high blood pressure and an altered breathing pattern point to raised intracranial pressure [bradycardia · hypertension]
  • Cholestatic form: prolonged jaundice with itching and pale stools, in fewer than 5% of patients, and it settles on its own [itching · jaundice · pale stools]

Tests (10)

  • Liver tests show raised bilirubin, transaminases and alkaline phosphatase, with ALT climbing 10 to 100 times normal and bilirubin rising later
  • Expect a mild lymphocytosis with a normal prothrombin time; if the prothrombin time drifts, suspect severe liver damage and encephalopathy risk
  • Anti-HAV IgM with the typical picture confirms it once other causes are excluded, and stays positive for 4 to 6 months
  • Anti-HAV IgG appears soon after infection and persists lifelong
  • PCR for viral RNA is an extra option but can read falsely negative during acute infection
  • Virus is detectable in stool shortly after ALT rises, though stool is not tested routinely
  • Abdominal ultrasound helps exclude other causes and separate cholestasis inside from outside the liver, but findings such as gallbladder wall and periportal oedema are non-specific
  • In the cholestatic variant, alkaline phosphatase and gamma-GT rise, and bile acids are high where there is itching
  • Suspect acute liver failure when the prothrombin time stays prolonged, and watch for the mildest encephalopathy
  • Worsening kidney function is a poor prognostic sign, and sepsis has to be excluded

If not this — what else fits (9)

  • Other viral hepatitis, notably hepatitis E and hepatitis B
  • Viruses that are not liver-specific: dengue, CMV, herpes simplex, Epstein-Barr
  • Parasitic and zoonotic illness: leptospirosis, rickettsial infection, Q fever, malaria and tropical fever syndromes
  • Liver injury caused by a drug
  • Autoimmune hepatitis
  • Ischaemic hepatitis
  • Alcohol-related hepatitis
  • Wilson disease
  • Acute Budd-Chiari syndrome

SourceStatPearls "Hepatitis A" - disease-level clinical article

Presentation findings are traced to the source above.

1

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg every 6 hours as needed (max 2 g daily in acute hepatitis) x 3-5 days as needed

Paediatric dose

10 mg/kg/dose [child max 500 mg]

(10 mg/kg every 8 hours as needed, no more than 3 doses in 24 hours - a ceiling of 30 mg/kg/day while the liver is inflamed.)

Dose by weight
3kg30 mg/dose
4kg40 mg/dose
5kg50 mg/dose
6kg60 mg/dose
7kg70 mg/dose
8kg80 mg/dose
9kg90 mg/dose
10kg100 mg/dose
11kg110 mg/dose
12kg120 mg/dose
13kg130 mg/dose
14kg140 mg/dose
15kg150 mg/dose
16kg160 mg/dose
17kg170 mg/dose
18kg180 mg/dose
19kg190 mg/dose
20kg200 mg/dose
21kg210 mg/dose
22kg220 mg/dose
23kg230 mg/dose
24kg240 mg/dose
25kg250 mg/dose
26kg260 mg/dose
27kg270 mg/dose
28kg280 mg/dose
29kg290 mg/dose
30kg300 mg/dose
31kg310 mg/dose
32kg320 mg/dose
33kg330 mg/dose
34kg340 mg/dose
35kg350 mg/dose
36kg360 mg/dose
37kg370 mg/dose
38kg380 mg/dose
39kg390 mg/dose
40kg400 mg/dose
41kg410 mg/dose
42kg420 mg/dose
43kg430 mg/dose
44kg440 mg/dose
45kg450 mg/dose
46kg460 mg/dose
47kg470 mg/dose
48kg480 mg/dose
49kg490 mg/dose
50kg500 mg/dose
Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

Dose reduced to max 2000 mg daily in acute viral hepatitis to avoid hepatotoxicity risk

Cautions
  • STRICT DOSE LIMIT: The maximum is 2 g/day in adults with acute hepatitis (half the standard dose).
  • Avoid all alcohol, hepatotoxic drugs, and unnecessary medications.
  • Refer urgently if encephalopathy, severe coagulopathy (prolonged PT/INR), or persistent vomiting develops.
  • The numbers now enforce what the note always said. At 15 mg/kg every 6 hours the weight card permitted 60 mg/kg/day, double the stated ceiling, in a child whose liver is the organ that is inflamed.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
2

ORS

add-on - not a substitute

Formoral.liquid

Adult dose and duration

Sip fluid/ORS solution frequently as needed to maintain hydration during acute illness. x 5-7 days as needed

Paediatric dose

Give frequent small sips to replace fluid loss from nausea or diarrhoea

Dose source

WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: WHO; 2005

Why

Glucose-electrolyte solution added to general supportive care to maintain hydration in a patient who may have reduced intake from nausea or vomiting; hepatitis A has no specific antiviral treatment, so supportive care is the mainstay.

Cautions
  • Never make the solution up in less water than the pack states. A five-fold concentrated ORS given to a dehydrated patient causes hypernatraemia, and an infant is the one least able to survive it.
  • Supportive care is paramount; no specific antiviral therapy exists for HAV.
  • Hygienic precautions: strict handwashing is needed to prevent household transmission.
  • Use the reduced-osmolarity formulation (sodium 75, glucose 75, potassium 20, citrate 10, chloride 65 mmol/L; 245 mOsm/L). WHO replaced the older 311 mOsm/L formula in 2002 for diarrhoea of any cause at any age - it cuts stool output and vomiting.
Egyptian brands
Egyptian brandManufacturerIndicative price
GLUCOHYDRAN 10 SACHET.ARAB DRUG COMPANY (ADCO)1.75 EGP
REHYDRAN N 10 SACHETCID4.50 EGP
REHYDRO ZINC 10 SACHETSCID7.00 EGP
ORS 20 SACHETSPHAROPHARMA40.00 EGP
ELECTRO MASH SYRUP 200 MLMASH PREMIERE60.00 EGP
FLEXOLYTE ORAL REHYDRATION SOL. 240 MLKEMPETRO FOR CHEMICAL INDUSTRIES65.00 EGP
HERO ORS 200 MLHERO > HERO MEA TRADING120.00 EGP
SANSO ORS SYRUP 140 MLAUG PHARMA400.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.