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Hepatic Encephalopathy & Hyperammonemia - #MEDSHED

Updated: Feb 5

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🚚 Hepatic Encephalopathy & Hyperammonemia - #MEDSHED



🤔 General


Neuropsychiatric complication of cirrhosis and/or porto-systemic shunting. Cirrhosis leads to impaired hepatic metabolism of ammonia. Cerebral edema develops from swollen astrocytes metabolizing excess ammonia in the brain.



Clinical Presentation


Nonspecific neurologic and psychiatric effects


AMS


Unresponsive


Hypertonia


Muscle rigidity


Hypokinesia



Advanced liver disease


Jaundice


Muscle wasting


Ascites


Sarcopenia



Acute Pharmacotherapy



Reduce production of ammonia and maximize removal of ammonia. Maintain potassium replacement as hypokalemia reduces renal elimination of ammonia. Address precipitating factors.



Lactulose


Hyperosmolar laxative that changes gastric pH, trapping intestinal ammonia, and processed for elimination


Rifaximin



20- 30 gm solution PO/FT q 1 - 2 hours PRN 2 to 3 bowel movements/day



200 gm enema rectally q 4 - 8 hours PRN



Rifaximin


Antibiotic that inhibits bacterial RNA synthesis, reduces ammonia-producing enteric organisms



Lactulose with rifaximin resolves HE more rapidly than lactulose alone



550 mg po BID



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Not medical advice. Educational purposes only. No relationships to report.



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