# Acute Viral Hepatitis A - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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 ## Treatment metadata - Paracetamol — 500 mg — oral.solid - ORS — oral.liquid ## Complete treatment card ```text ACUTE VIRAL HEPATITIS A 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 Review status: REVIEWED against 2 sources listed above (2026-08) 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 Source StatPearls "Hepatitis A" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 500 mg every 6 hours as needed (max 2 g daily in acute hepatitis) x 3-5 days as needed Peds 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.) 3kg -> 30 mg/dose 4kg -> 40 mg/dose 5kg -> 50 mg/dose 6kg -> 60 mg/dose 7kg -> 70 mg/dose 8kg -> 80 mg/dose 9kg -> 90 mg/dose 10kg -> 100 mg/dose 11kg -> 110 mg/dose 12kg -> 120 mg/dose 13kg -> 130 mg/dose 14kg -> 140 mg/dose 15kg -> 150 mg/dose 16kg -> 160 mg/dose 17kg -> 170 mg/dose 18kg -> 180 mg/dose 19kg -> 190 mg/dose 20kg -> 200 mg/dose 21kg -> 210 mg/dose 22kg -> 220 mg/dose 23kg -> 230 mg/dose 24kg -> 240 mg/dose 25kg -> 250 mg/dose 26kg -> 260 mg/dose 27kg -> 270 mg/dose 28kg -> 280 mg/dose 29kg -> 290 mg/dose 30kg -> 300 mg/dose 31kg -> 310 mg/dose 32kg -> 320 mg/dose 33kg -> 330 mg/dose 34kg -> 340 mg/dose 35kg -> 350 mg/dose 36kg -> 360 mg/dose 37kg -> 370 mg/dose 38kg -> 380 mg/dose 39kg -> 390 mg/dose 40kg -> 400 mg/dose 41kg -> 410 mg/dose 42kg -> 420 mg/dose 43kg -> 430 mg/dose 44kg -> 440 mg/dose 45kg -> 450 mg/dose 46kg -> 460 mg/dose 47kg -> 470 mg/dose 48kg -> 480 mg/dose 49kg -> 490 mg/dose 50kg -> 500 mg/dose Source MSF Essential Drugs 2024 - paracetamol (oral) Why Dose reduced to max 2000 mg daily in acute viral hepatitis to avoid hepatotoxicity risk Caution 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. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. ORS [add-on - not a substitute] Adult Sip fluid/ORS solution frequently as needed to maintain hydration during acute illness. x 5-7 days as needed Peds Give frequent small sips to replace fluid loss from nausea or diarrhoea 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. Caution 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. Egypt GLUCOHYDRAN 10 SACHET. ARAB DRUG COM... 1.75 EGP REHYDRAN N 10 SACHET CID 4.50 EGP REHYDRO ZINC 10 SACHETS CID 7.00 EGP ORS 20 SACHETS PHAROPHARMA 40.00 EGP ELECTRO MASH SYRUP 200 ML MASH PREMIERE 60.00 EGP FLEXOLYTE ORAL REHYDRATION SOL. 240 ML KEMPETRO FOR CHEMICAL INDUSTRIES 65.00 EGP HERO ORS 200 ML HERO > HERO M... 120.00 EGP SANSO ORS SYRUP 140 ML AUG PHARMA 400.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)