Pharmacy & Acute Care University
Pharmacy & Acute Care University
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Acute Complications of Cirrhosis Masterclass by Sarah Kessler, PharmD, BCPS, BCGP

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  1. Introduction

    Background
  2. Diagnostics
    Diagnostics & Screening
  3. Cirrhosis Complications
    Portal Hypertension
  4. Ascites
  5. Spontaneous Bacterial Peritonitis (SBP)
  6. Varices
  7. Hepatic Encephalopathy
  8. Hepatorenal Syndrome (HRS)
  9. Conclusion
    Summary

Participants 426

  • Allison Clemens
  • April
  • ababaabhay
  • achoi2392
  • adhoward1
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  • 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+