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
  Asterixis
  Stigmata of cirrhosis
• Diagnosis:
  Delta waves (EEG)
• Treatment:
  Lactulose (decreases ammonia absorption)
  Neomycin (decreases ammonia production)
  Laxatives
• Notes:
  ABXs decrease the number of ammonia-producing bacteria
• Associated With:
  CIrrhosis , ESLD