Hepatic Encephalopathy (HE) Flashcards
1
Q
HE patho
A
decrease number of functioning hepatocytes
dec ammonia detoxification of blood
increased ammonia to brain causes AMS
2
Q
what do we monitor in HE to tell severity
A
mental status NOT ammonia
3
Q
HE tx non pharm
A
- remove precipitating factors: opioids, benzos
- change dietary protein to veggie or dairy sourced which still produce ammonia but are less likely to cross BBB
4
Q
HE tx pharm
A
-lactulose: dec clonic pH, traps ammonia as NH4 ammonium
ACUTE: 25mL po q1-2h until 2+ loose stools OR retention enema 300mL x1hr q6-12h
DISCHARGE: 15-60 mL q6-12h (want 2-3 soft BM/day)
-rifaximin
add on to lactulose; dec bacteria in gut that produce NH3
ACUTE: 400mg po q8h
DISCHARGE: 550mg po BID
