If you have jaundice (yellow eyes/skin) with severe fatigue, confusion, or bleeding tendency — call 10177 or go to the nearest emergency room immediately.
Most chronic hepatitis B is managed as a stable outpatient condition. Acute hepatitis B and complications of advanced chronic disease can, however, progress rapidly to liver failure — a life-threatening emergency.
Acute Hepatitis B — Medical Emergency
While 90–95% of adults with acute HBV clear the infection spontaneously, a small proportion (1–3%) develop acute liver failure — fulminant hepatic failure.
Symptoms of severe acute hepatitis B: - Deep jaundice (profound yellowing of skin and whites of eyes) - Confusion, disorientation, or altered behaviour (hepatic encephalopathy) - Bruising or bleeding easily (coagulopathy) - Severe abdominal distension (ascites developing rapidly) - Extreme fatigue — unable to function - Dark urine, pale stools
Action: Call 10177 or go to the ER immediately. Acute liver failure is a medical emergency requiring intensive care and urgent specialist evaluation. PMB-covered as an acute hepatic emergency.
Hepatic Encephalopathy — Chronic Liver Failure Complication
In patients with established cirrhosis from chronic HBV, hepatic encephalopathy — brain dysfunction caused by accumulated toxins the failing liver cannot remove — can develop rapidly with a triggering event (infection, GI bleeding, constipation, missed lactulose doses, dehydration).
Symptoms: Confusion, drowsiness, disorientation, sleep disturbance, "flapping tremor" of the hands (asterixis), in severe cases: coma.
Action: ER immediately. Hepatic encephalopathy is a PMB-covered hospitalisation emergency. Treatment: lactulose, rifaximin, identify and treat the precipitating cause.
Variceal Bleeding — Upper GI Emergency
Cirrhosis causes portal hypertension — increased pressure in the portal vein system. This causes oesophageal varices (dilated, fragile veins in the oesophagus). Variceal rupture causes massive, life-threatening upper GI bleeding.
Symptoms: Vomiting large amounts of fresh blood or coffee-ground material; passing large amounts of dark tarry stools (melaena); fainting, collapse.
Action: Call 10177 immediately. Variceal bleeding has a high mortality rate. Emergency endoscopy (variceal band ligation or injection sclerotherapy) + resuscitation is required within hours. This is a PMB emergency — covered.
Spontaneous Bacterial Peritonitis (SBP)
Patients with ascites (fluid in the abdomen from cirrhosis) are at risk of SBP — spontaneous bacterial infection of the ascitic fluid without a primary source. SBP can rapidly cause septic shock.
Symptoms: Worsening abdominal pain and distension, fever, worsening jaundice, confusion.
Action: ER immediately. Diagnostic paracentesis + IV antibiotics within hours. PMB-covered.
Emergency Coverage Summary
| Situation | PMB Status | Action |
|---|---|---|
| Acute liver failure (fulminant hepatitis B) | Yes — emergency PMB | 10177 / ER immediately |
| Hepatic encephalopathy (confusion, drowsy) | Yes — PMB (cirrhosis complication) | ER immediately |
| Variceal haemorrhage (vomiting blood) | Yes — PMB (GI haemorrhage DTP) | 10177 immediately |
| Spontaneous bacterial peritonitis (SBP) | Yes — PMB (sepsis DTP) | ER immediately |
| Hepatocellular carcinoma complication | Yes — PMB (oncology DTP) | Urgent oncology/hepatology assessment |
| Needle-stick exposure + HBV PEP | Yes — PMB (occupational/post-exposure) | Same-day HBIG + vaccination |
Needle-Stick Injury — Hepatitis B Post-Exposure Prophylaxis
Healthcare workers or others with blood exposure to a known HBsAg-positive person:
If you are not vaccinated or have unknown immunity: go to the ER or occupational health immediately — within 24 hours (ideally within 12 hours).
HBV post-exposure prophylaxis (PEP): Hepatitis B immunoglobulin (HBIG) + hepatitis B vaccination given together. HBIG provides immediate passive immunity; the vaccine provides long-term active immunity.
After 24 hours, HBIG is less effective. After 7 days, HBIG is not indicated.
HBIG and post-exposure vaccination are PMB-covered as an emergency preventive measure.
If HCC Is Detected on Surveillance
If a liver lesion suspicious for hepatocellular carcinoma is detected on your surveillance ultrasound:
- Urgent referral to hepatologist or liver surgeon
- Triple-phase CT or MRI liver for characterisation (LI-RADS grading)
- MDT (multidisciplinary team) assessment: hepatology, oncology, liver surgery, radiology
- HCC treatment options: surgical resection (early disease), liver transplant (selected), transarterial chemoembolisation (TACE), radiofrequency ablation (RFA), sorafenib/lenvatinib (advanced disease)
HCC is a PMB condition (cancer DTP). All of the above is PMB-covered for treatment.
If Your Antiviral Is Suddenly Interrupted
Do not stop tenofovir without medical guidance. Sudden interruption of TDF in chronic HBV can cause a severe flare of hepatitis (HBV rebound — the immune system attacks newly replicating virus). In a patient with cirrhosis, this can precipitate liver failure.
If you face a financial or formulary barrier to your tenofovir: 1. Call your scheme immediately — ask them to confirm cover for your chronic Hepatitis B antiviral and to authorise continued supply. (Chronic HBV is not a CDL condition, so cover depends on your scheme's chronic-condition rules — but an interruption that risks liver failure is a clinical emergency.) 2. Generic tenofovir is available at most SA pharmacies for R200–R600/month — if needed as a temporary measure. 3. Council for Medical Schemes: 0861 123 267 — for medication funding disputes.
Resources and Helplines
Emergency services: 10177 (ambulance) | 10111 (police) ER24 (private ambulance): 084 124 Netcare 911 (private ambulance): 082 911 CANSA helpline: 0800 22 6622 (hepatocellular carcinoma) Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za Talk to Eldon →