DECISION POINT: Diagnosis & Initial Management

Nurse Rina asks, "Doc, the results are extremely high. What should I do? Is this just viral hepatitis? Do I continue the TB drugs?"

"Such high AST/ALT must be a severe infection, possibly cholangitis. Stop the anti tuberculosis drug and start broad-spectrum antibiotics immediately."
"This is a severe Drug-Induced Liver Injury (DILI) from the anti tuberculosis drug.
"This is likely a coincidental acute viral hepatitis. Continue the anti tuberculosis drug to prevent resistance. Give a liver supplement and refer for hepatitis serology.
"Reduce the anti tuberculosis drug 4-FDC dose to half. Let's monitor for 3 more days. Maybe his liver is just need some adjusting dose.

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