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November 1978

Management of Fulminant Hepatitis by Vigorous Supportive Treatment

Arch Intern Med. 1978;138(11):1749. doi:10.1001/archinte.1978.03630360113046

To the Editor.—  Fulminant hepatitis is a highly fatal disease and, in spite of various therapies that have been tried in the last decades, viz, the administration of high doses of corticosteroids, exchange transfusion, charcoal hemoperfusion, total body washout, and cross circulation with animal or human liver,1 the mortality has not registered any substantial decline. Auslander and Gitnick (Archives 137:599-601, 1977) have reported good results with aggressive medical management without the use of corticosteroids and other special modes of therapy.We have treated 69 patients with fulminant hepatitis during the last five years in our institution. The criteria of Redker2 were used to establish the diagnosis. Initially, 22 patients were given high doses of corticosteroids and only three (14%) of them survived. Subsequently, exchange transfusion was used in ten patients and all of them died. Septicemia, hepatorenal failure, and gastrointestinal bleeding were the major fatal complications that prompted

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