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What is the treatment for norovirus infection?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

I am a 53-year-old male and a norovirus infection hit right after a liver transplant. I cannot keep Tacrolimus down and ALT 876 IU/L. I am getting confused and ammonia is 125 micrograms per deciliter. How long before permanent damage? Should we switch to IV immunosuppression? Is a feeding tube safer than oral medicines?

Thanks.

Hi,

Welcome to icliniq.com.

I can understand your concern.

This is a critical situation and based on what you have described, urgent medical intervention is needed. If Tacrolimus levels are too low due to vomiting, rejection is a real risk, especially with rising ALT (alanine transferase). IV (intravenous) immunosuppression like IV tacrolimus or steroids, should be considered. If you cannot hold medicines down due to vomiting, IV medication should be taken. A feeding tube could be considered, but only if your gut is functioning well and you are not at risk of aspiration. Elevated ammonia confusion indicates moderate to severe hepatic encephalopathy. It can progress rapidly if it remains untreated and may lead to permanent damage. Lactulose and Rifaximin can help lower ammonia, but you will need closer monitoring. It is better to start these medicines in a hospital, mostly in an ICU (intensive care unit) setup. You should immediately be admitted to a hospital with an ICU facility and stay on IV medication.

The doctors must monitor liver function, Tacrolimus levels, electrolyte levels, and kidney function closely. This situation is time-sensitive. Permanent damage depends on how quickly rejection and hepatic encephalopathy are controlled. The sooner you get proper treatment, the better your chances of recovery. There is no specific treatment for norovirus but by following some rules, you can recover soon. Stay hydrated. Take small sips of water, ORS (oral rehydration solution), or coconut water. If you cannot drink due to vomiting, IV fluids are a good choice. For vomiting, you can take IV medication like Ondansetron or Metoclopramide.

I hope this information will help you.

Thanks.

Medically reviewed byiCliniq medical review team

Published At March 12, 2025
Reviewed AtMarch 12, 2025

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