HE

Question 1

HE

Answer 1

dec hepatic function + portal systemic shunting

Question 2

Ammonia

Answer 2

• can measure levels for diagnosis but don’t continue to measure, monitor mental status
• do not correlate with severity

Question 3

Treatment

Answer 3

• remove precipitating factors (opioids, benzos)

- Dietary protein (switch pt to dairy or veg protein sources vs. animal)

Question 4

Ammonia in GI tract

Answer 4

• lactulose (nonabsorable disaccharide)
• gut flora ferment this - organic acid which lower colonic pH - enhances movement of ammonia from blood - bowel - gets trapped in bowel - eliminated in feces
• Acute enceph: Po 25 ml q1-2 hr until they have at least 2 loose/watery stools
• Edema: 300 ml retention edema, retain for 1 hr, given every 6-12 hrs
• Prevention HE: 15-60 ml q6-12 hrs (2-3 soft BM/day)

Question 5

Rifaximin

Answer 5

• Add on to lactulose ( dec bacteria that produce ammonia)
• Acute: 400 mg PO q8h
• Maintenance: 550 mg po bid
• well tolerated
• almost all trial pts used in combo w/ lactulose