What're the treatments for liver encephalopathy?
The goals of treatment include life support, elimination or treatment of precipitating factors, and removal or neutralization of ammonia and other toxins. Life support including support of breathing or circulation may be required, particularly if coma
develops. Cerebral edema (brain swelling) may occur and may be life-threatening.
This condition may disappear if the cause of symptoms is eliminated. In other cases, treatment is designed to improve liver function as much as possible; remove or relieve factors that worsen symptoms; and decrease the body's production of poisonous substances. All non-essential medications are discontinued. Soft restraints are recommended in place of sedatives for patients who become agitated.
Enemas or laxatives are used to stimulate expulsion of toxic intestinal products. All or most protein is eliminated from the diet, and supplemental feeding may be necessary to replenish lost calories. Regular doses of neomycin (Neobiotic), taken orally or administered to comatose patients in liquid form through a tube, may be used to decrease production of protein-digesting bacteria in the bowel.
Sedatives, tranquilizers, or any other medication that is metabolized or excreted by the liver should be avoided. Medications containing ammonium (including certain antacids) should be avoided. Other medications and treatments may be recommended, with variable results.
Lactulose, a synthetic sugar, changes the characteristics of intestinal bacteria, decreases the amount of ammonia accumulated in the body, and has laxative properties. The patient is given hourly doses of lactulose syrup until diarrhea occurs, then dosage is adjusted to maintain regular bowel function. Lactulose and dietary-protein restrictions may be used to control chronic encephalopathy.
The treatment of hepatic encephalopathy is empirical and relies largely on establishing the correct diagnosis, identifying and treating precipitating factors, emptying the bowels of blood, protein, and stool, attending to electrolyte and acid-base imbalance, and the selective use of benzodiazepine antagonists. Non-absorbable disaccharides, such as lactulose or lactitol, are the mainstay of treatment. |
