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Introduction
Background -
DiagnosticsDiagnostics & Screening
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Cirrhosis ComplicationsPortal Hypertension
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Ascites
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Spontaneous Bacterial Peritonitis (SBP)
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Varices
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Hepatic Encephalopathy
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Hepatorenal Syndrome (HRS)
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ConclusionSummary
Participants 396
- Spectrum of neuropsychiatric and psychometric abnormalities
- Often diagnosed by clinical observation after excluding other possible causes
- Significant contributor to morbidity, mortality, and healthcare costs
Ammonia Hypothesis
Hepatic Encephalopathy
HE Treatment
| Therapy | Mechanism | Dosing |
| 1ST LINE THERAPY | ||
| Lactulose | Non-absorbable disaccharide | Initial: 25mL q1-2h until first bowel movement
Maintenance: Titrate to maintain 2-3 bowel movements per day |
| ADJUNCT | ||
| Rifaximin | Antibiotic alters gut flora, reduces ammonia producing bacteria | Maintenance: 550 mg BID |
| 2ND LINE THERAPY | ||
| Transplant | ||
Lactulose MOA
- Releases hydrogen ions → bind to ammonia, creating ammonium
- Positively charged and unable to cross the cell membrane to enter the bloodstream
- Produces an osmotic effect causing rapid laxation
Lactulose Adverse Effects
- Gastrointestinal:
- Bloating
- Abdominal cramping
- Flatulence
- Nausea/vomiting
- Diarrhea
- Electrolyte imbalances:
- ↑ Na+
- ↓ K+