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Hepatic Encephalopathy & Hyperammonemia - #MEDSHED

Updated: Feb 5

Welcome to the #MEDSHED! Needing a brief, concise review of clinical pharmacotherapy and disease management? Direct links of reference to content discussed? Look no further than the #MEDSHED series based on infographics and carousel presentations!


🚚 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




Muscle rigidity


Advanced liver disease


Muscle wasting



Acute Pharmacotherapy

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


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


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


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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