Hepatic Encephalopathy
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
CLINICAL FEATURES
Precipitants of the condition include, GI bleeding, constipation, high protein meal, hypokalemic alkalosis, CNS depressant tremors, change in personality that can include being violent and hard to drugs, hypoxia, hypercarbía, sepsis. Confusion, slurred speech, flapping manages to being sleepy and difficult to arouse.
INVESTIGATIONS
LFTS, CBC, serum electrolytes, RBS, culture of blood, urine, sputum, and ascites. Exclude GI bleed (HB, history of melena), or evidence of renal impairment, U / S Abdomen or CT scan may show evidence of portal hypertension.
MANAGEMENT
Pass NG tube and catheterize the patient Identify and treat the cause (e.g., constipation, drugs, viral hepatitis, septicemia, Toxins, alcohol or upper G.I bleeding).
Provide non protein containing high calorie food (2000kCal / day).
Kleen enema stat then once daily (if patient is constipated)
Syp- Duphalac / Lilac (lactulose) 6 TSF PO x 1 hourly till stool is passed, then 6 TSF PO x TDS till patient become stable and well oriented then 2 TSF PO x TDS for home therapy. (Aim should be passing 2-3 stool in 24 hours)
Inf- dextrose 10 % 1L IV x TDS with 2gm KCI added to every liter if patient has hypoglycemia, hypokalemia and renal functions are satisfactory).
Check for any infection and treat immediately with Inj - Claforan (cefotaxime) 2gm IV x TDS ' Or ' Inj - Oxidil / Rocephin (ceftriaxone) 2 gm IV x OD (ATD)
Tab - Rifaxa (Rifaxamin )550mg, PO x BD or TDS
If signs of bleeding are present transfuse Fresh Frozen Plasma + Inj- Vitamin K 10mg IV x stat
Transfuse Platelets if count < 50000 and patient is still bleeding.
If ethanol etiology is suspected give: Inj- Thiamine 10mg IV x OD before dextrose infusion and continue daily for 3 days.
Note: Avoid use of all unnecessary drugs including diuretics and sedatives.