Question of the Week

Question :

Posted On : 07 Mar 2009

Current concepts on management of Hepatic Encephalopathy

Expert Answer :

No expert answer available.

Answer Discussion :

SANTOSH POLISHETTY

reduction of production and absprption of ammonai, increased metabolism of ammonia in the tissues,reduction of false neurotransmitters,inhibition of aminobutyric acid and benzodiazepine receptors,correction of manganeese deposition in the basal ganglia,orthotopic liver transplantation

16 years ago

vetri vela

Iv fluids, Lactulose, Neomycin, Sodium Benzoate,

16 years ago

Ramana Chilukuri

lactulose gut sterilisation with metronidazole dialysis

16 years ago

pediatriconcall

Most current therapies are designed to treat the hyperammonemia that is a hallmark of most cases of hepatic encephalopathy. Protein restricted diet with rich in branched-chain amino acids. However avoid PEM state. Lactulose and neomycin are still recommended. Rifaximin, a nonabsorbable derivative of rifampin been used in the treatment of hepatic encephalopathy. A number of concerns remain regarding rifaximin`s role in the treatment of hepatic encephalopathy. It remains to be determined if rifaximin can improve severe encephalopathy symptoms as rapidly as lactulose. L-ornithine L-aspartate {LOLA} can increase ammonia clearance. Their administration results increased glutamate levels. Ammonia is subsequently used in the conversion of glutamate to glutamine by glutamine synthetase. LOLA was found to be effective in treating hepatic encephalopathy in a number of European trials. Zinc deficiency is common in cirrhosis. Even in patients who are not zinc deficient, zinc administration has the potential to improve hyperammonemia by increasing the activity of ornithine transcarbamylase, an enzyme in the urea cycle. The subsequent increase in ureagenesis results in the loss of ammonia ions. Sodium benzoate, sodium phenylbutyrate, sodium phenylacetate can be used to treat severe hyperammonemia. L-carnitine improved hepatic encephalopathy symptoms in several small studies of patients with cirrhosis.30 Whether the medication works by improving blood ammonia levels or whether it works centrally perhaps by decreasing brain ammonia uptake remains unclear.

16 years ago

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