Fever, Nausea, Loss of Appetite, and Dark Urine – Be Aware of Acute Hepatitis E
Acute Hepatitis E is a common type of viral hepatitis, especially among adults. It is primarily transmitted through the fecal-oral route and often presents with symptoms such as fever, jaundice, fatigue, and gastrointestinal discomfort. Although most cases are self-limiting, some patients may develop severe hepatitis, which can be life-threatening. The main treatment approach involves liver protection, enzyme reduction, jaundice relief, and supportive care. With timely and appropriate treatment, most patients can achieve a full recovery.
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Patient Profile
A 62-year-old female with no significant medical history was admitted to Liaoning Provincial People's Hospital in April 2019. She was diagnosed with acute icteric Hepatitis E and underwent a 21-day inpatient treatment followed by a one-month outpatient follow-up. Her symptoms improved significantly, and she made a full recovery.
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Initial Presentation
The patient came in complaining of fever, fatigue, loss of appetite, nausea, and dark urine for seven days. She had no known triggers for her symptoms and initially experienced fever without measuring her temperature. As her condition progressed, her urine turned dark yellow, resembling strong tea. Blood tests revealed abnormal liver function, prompting her to seek further treatment at our hospital.
Physical examination showed moderate jaundice of the skin and sclera, with no palpable liver or spleen. Liver function tests showed elevated ALT (291.1 U/L), AST (120.4 U/L), GGT (82 U/L), and total bilirubin (141.4 μmol/L). Based on these findings, she was preliminarily diagnosed with acute icteric Hepatitis E and admitted for isolation and treatment.
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Treatment Plan and Progress
Upon admission, the patient was placed under level-two infectious disease care and required gastrointestinal isolation. Further tests confirmed acute Hepatitis E through positive IgG and IgM antibodies.
Her treatment included intravenous therapy with Compound Dipropylacetate, Magnesium Isoglycyrrhizinate, and Polyporus Umbellatus Polysaccharide Peptide to support liver function and immunity. Oral medications such as Silymarin and Yinzhihuang Granules were given to reduce liver enzymes and jaundice.
However, after using S-Adenosylmethionine, she developed side effects including tinnitus and sore throat, suggesting an allergic reaction. The drug was immediately discontinued, and she was switched to L-Ornithine L-Aspartate for jaundice management. Additionally, due to hypoalbuminemia, she received human albumin infusions.
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Recovery and Discharge
After three weeks of treatment, her symptoms significantly improved. Her appetite returned, gastrointestinal symptoms subsided, and her urine color normalized. Liver function tests showed progressive improvement, and she entered the recovery phase. Upon discharge, she was advised to return for a follow-up visit one month later.
Although her liver enzymes had returned to near-normal levels, full liver cell recovery typically takes at least three months. Therefore, she was advised to continue resting, avoid alcohol and unnecessary medications, maintain a balanced diet rich in vitamins, and gradually increase physical activity.
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Key Insights and Prevention Tips
Hepatitis E is often self-limiting, but timely medical intervention is crucial to manage symptoms and prevent complications. Most patients recover fully with supportive care, including liver-protecting medications and proper nutrition.
Albumin levels drop during liver damage, especially when combined with poor dietary intake. When serum albumin falls below 30 g/L, patients are at risk of developing ascites or pleural effusion, making intravenous albumin supplementation necessary.
Prevention plays a vital role in avoiding Hepatitis E. Practicing good hygiene, maintaining a regular diet, and avoiding excessive alcohol and medications can significantly reduce the risk. If symptoms like nausea, jaundice, or fatigue occur, prompt medical attention is recommended.
By following medical advice and maintaining a healthy lifestyle, patients can recover smoothly and reduce the chances of relapse or long-term complications.