Hepatic encephalopathy

  • Facts:
    Due to poor hepatic clearance of toxins
    Accumulation of ammonia (liver inability to detoxify ammonia into urea)
  • History / PE:
    Day-night reversal
    Mild confusion
    Stigmata of cirrhosis
  • Diagnosis:
    Delta waves (EEG)
  • Treatment:
    Lactulose (decreases ammonia absorption)
    Neomycin (decreases ammonia production)
  • Notes:
    ABXs decrease the number of ammonia-producing bacteria
  • Associated With:
    CIrrhosis , ESLD

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August 2nd 2010