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I was gratifying to learn that Drs Vij and Tandon and their associates have been able to confirm results published by our group in which we advocated aggressive but conservative medical management of fulminant hepatic failure. Although our results are comparable, there are some differences in our approaches to management. For example, we employed neomycin as a standard form of management in each of our patients, whereas Drs Vij and Tandon empirically used ampicillin. I quite agree with them that the use of conservative but aggressive medical management is appropriate in the treatment of fulminant hepatic failure. Careful observation of fluid and electrolyte management, the employment of fresh frozen plasma to maintain satisfactory prothrombin levels, and close monitoring of blood gases represent a superior means of treatment when compared with more unique but potentially harmful approaches.
Gitnick GL. Management of Fulminant Hepatitis by Vigorous Supportive Treatment-Reply. Arch Intern Med. 1978;138(11):1749-1750. doi:10.1001/archinte.1978.03630360113047