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Knowing The Procedure Of Mysterious Acute Hepatitis

During July 2022, WHO said there were 35 countries that had reported 1,010 suspected cases of mysterious acute hepatitis in children with a death toll of 22 cases. Indonesia is one of the 35 countries, with the latest data released by the Ministry of Health on July 12th, 2022, there are at least 80 cumulative cases of suspected mysterious acute hepatitis spread across 22 provinces. This means that the Indonesian people themselves need to be aware of the mysterious acute hepatitis. It is necessary to know the management of prevention and treatment that needs to be done to deal with this mysterious hepatitis.

In addition to the cause, the method of transmission of mysterious acute hepatitis is still unknown, but it is suspected that the disease is transmitted through direct contact or inhalation of droplets from coughs or sneezes from people with acute hepatitis. For this reason, health protocols are needed to prevent transmission, such as:
1. ) Always wash your hands with soap
2. ) Washing food until clean
3. ) Ensure food is cooked and clean
4. ) Using your own cutlery
5. ) Avoid contact with sick people
6. ) Wear a mask and keep your distance

The Indonesian Pediatrician Association has also issued guidelines for the management of infected patients, with two mechanisms of designation, namely the management of severe acute hepatitis and acute liver failure or fulminant hepatitis.

The category of patients with severe acute hepatitis is those whose consciousness has decreased or not, but the International Normalized Ratio (INR) value is not more than 2. Meanwhile, patients are categorized as fulminant hepatitis if they have decreased consciousness or not, but their INR exceeds (> ) 2.

INR is an international standardized normal ratio recommended by the World Health Organization (WHO) which is often used for measuring prothrombin time (PT or Prothrombin Parameters) and as a guideline for anticoagulant therapy.

Category severe acute hepatitis
1. ) General care: isolation room, acute phase bed rest, monitoring of clinical course such as consciousness and laboratory, and recognition of symptoms and signs of fulminant hepatitis
2. ) Monitor PT/INR periodically, normal INR values ​​in the range 0.8-1.1. An increased INR value is an indication of liver disease.
3. ) Corticosteroid therapy for suspected autoimmune hepatitis Monitor for multisystem inflammatory syndrome in children (MISC)

Category Fulminant hepatitis
1. ) Intensive care and close monitoring
2. ) Quiet indoor treatment with minimal stimulation to reduce sudden increase in intracranial pressure
3. ) Change the total restricted fluid requirement to 85-90 percent maintenance, to reduce the risk of cerebral edema. Hypovolemia or dehydration must be corrected immediately
4. ) Providing nutrition through a nasogastric tube (NGT) for nutritional fulfillment
5. ) Monitoring oxygen saturation, urine output per 6 hours, vital signs per 6 hours, electrolytes and PT/INR per 12 hours, complete peripheral blood examination per day, blood and urine cultures at the beginning of treatment and repeated throughout the stay according to the clinical course.
6. ) Drugs such as intravenous dextrose, systemic antibiotics, prophylactic oral antifungals, acyclovir in neonates, intravenous N-acetylcysteine (NAC), sedation for patients requiring mechanical ventilation.

The above treatment will be followed up further and have different treatments and drugs if the patient has complications.

If you or your child experience complaints with symptoms that point to mysterious acute hepatitis, you can consult a doctor through the mDoc application for proper management and treatment.