Test Your Guidelines Knowledge

A man of 32 years with a history of type 1 diabetes and vitiligo is referred by his GP because of jaundice (noticed 5 days ago), fatigue, anorexia and vague upper abdominal discomfort. He usually drinks 3 to 4 beers per day but during the weekend, he consumes quite a substantial amount of alcohol during parties. The last 4 weekends the parties were particularly heavy in terms of alcohol consumption. Clinically he is deeply jaundiced, without any further signs of chronic liver disease. BMI 33 kg/m2, BP 105/65 mm Hg, PR 92/min; AST 234 U/L, ALT 180 U/L, bilirubin 28 mg/dL (478 micromole/L), INR 2.5, creatinine 1.5 mg/dL (133 micromole/L), leucocytes 3.6x109/L, platelets 310x109/L; CRP 58 mg/dL; viral serology is negative. Ultrasound shows an enlarged hyperechoic liver and splenomegaly (14 cm). Fibroscan® VCTE 17 kPa. Because of cough and a suspicion of pneumonia, IV antibiotics are started. After 2 days, the situation has hardly changed, besides a small drop in CRP of 45 mg/dL and no clear infiltrate on chest XR.

Which of the following would you consider to be the correct approach, besides treating the alcohol use disorder?