1. A 33-year-old man presents with ALF secondary to acetaminophen overdose.

He is now
72 hours post-ingestion and is profoundly encephalopathic and unresponsive to pain on
examination. An ICP monitor is placed, which shows acute elevations of 30 mm Hg.
Which is most appropriate for the acute management of ICP elevations?
a. Hypertonic saline continuous infusion to maintain serum sodium 145–155 mEq/L.
b. Mannitol 0.5 mg/kg intravenously × 1.
c. Hyperventilation to Paco2 of 25–30 mm Hg.
d. Thiopental continuous infusion.

Laki-laki 33 tahun menunjukkan ALF sekunder akibat overdosis asetaminofen. Sekarang,

72 jam setelah mengonsumsi asetaminofen dan sangat ensefalopati dan tidak responsif
terhadap rasa sakit pada pemeriksaan. Monitor ICP ditempatkan, yang menunjukkan
peningkatan akut 30 mm Hg. Mana yang paling tepat untuk manajemen akut
peningkatan ICP?
Patient Cases Viral Hepatitis
1. A 45-year-old woman with a history of intravenous drug abuse is evaluated in the clinic
for chronic HBVinfection. Although she received the HBV diagnosis 8 months ago, she
has not been treated for it. Laboratory values reported today include HBsAg positive,
HBeAg positive, AST 650 IU/mL, ALT 850IU/mL, HBV DNA 107,000 IU/mL, SCr 0.9
mg/dL, INR 1.3, and albumin 3.9 g/dL. She has no evidenceof ascites or encephalopathy.
A liver biopsy reveals severe necroinflammation and bridging fibrosis. Resistance
testing reveals the presence of the YMDD mutation. What is the best course of action?
a. Withhold drug therapy and recheck HBV DNA in 6 months.
b. Initiate pegylated interferon alfa-2a plus ribavirin.
c. Initiate lamivudine 100 mg/day.
d. Initiate tenofovir 300 mg/day.
Patients who meet the criteria for chronic infection should be treated. Choice of initial
therapy is based on patient profile, prior treatments, contraindications to drug therapy,
and medication and monitoring costs.
Seorang wanita 45 tahun dengan riwayat penyalahgunaan obat intravena dievaluasi di
klinik untuk infeksi HBV kronis. Meskipun dia menerima diagnosis HBV 8 bulan yang
lalu, dia belum dirawat untuk itu. Nilai laboratorium yang dilaporkan hari ini termasuk
HBsAg positif, HBeAg positif, AST 650 IU/mL, ALT 850 IU/mL, HBV DNA 107.000
IU/mL, SCr 0.9 mg/dL, INR 1.3, dan albumin 3.9 g/dL. Dia tidak memiliki bukti asites
atau ensefalopati. Biopsi hati menunjukkan peradangan nekro yang parah dan bridging
fibrosis. Pengujian resistensi mengungkapkan adanya mutasi YMDD. Apa tindakan
terbaik?