A 45-year-old man with long-standing heavy alcohol use presents with 3 weeks of anorexia, fever, tender hepatomegaly, and jaundice. Total bilirubin is 8 mg/dL, prothrombin time is 22 seconds with control 12 seconds, AST 180 U/L, ALT 70 U/L. No infection is identified. What is the most appropriate specific therapy?

• A N-acetylcysteine infusion
• B Prednisolone 40 mg daily ✓
• C Ursodeoxycholic acid
• D Supportive care with thiamine alone

Explanation

The Maddrey discriminant function is 4.6 times (prothrombin minus control) plus bilirubin: 4.6 x 10 plus 8 equals 54. B discriminant function above 32 identifies severe alcoholic hepatitis with high short-term mortality, for which prednisolone 40 mg daily improves survival. The AST to ALT ratio above 2 with values under 400 U/L supports the diagnosis. Ursodeoxycholic acid has no role, and N-acetylcysteine is adjunctive rather than definitive here.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.