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Drugs used in Hepatic encephalopathy

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prabin kumar bam, introduction of hepatic encephalopathy, treatment measures, drugs used in hepatic encephalopathy, management of hepatic encephalopathy, role of lactulose, role of antibiotics (Rifaximin), nutrition, liver transplantation, prophylaxis,

prabin kumar bam, introduction of hepatic encephalopathy, treatment measures, drugs used in hepatic encephalopathy, management of hepatic encephalopathy, role of lactulose, role of antibiotics (Rifaximin), nutrition, liver transplantation, prophylaxis,

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Drugs used in Hepatic encephalopathy

  1. 1. DRUGS USED IN HEPATIC ENCEPHALOPATHY Prabin Kumar Bam Chitwan Medical College Bharatpur, Nepal 2/1/2019 1
  2. 2. Hepatic Encephalopathy • Hepatic encephalopathy is a brain dysfunction caused by liver insufficiency and/or portosystemic shunt. • In this disorder, nitrogenous waste products (chiefly ammonia) accumulates in systemic circulation. Then they cross blood-brain barrier, enter brain and affect it. • Symptoms: Personality changes, intellectual impairment, decresed consciousness and coma in the advanced stage. 2/1/2019 2
  3. 3. Treatment measures Hospitalization Maintain ABC Remove the cause and precipitating factor. IV dextrose, saline and Inj. Thiamine. Reduce ammonia load. Proper nutrition Inj. Vitamin K Liver transplantation. 2/1/2019 3
  4. 4. Non absorbable disaccharides • Lactulose • Lactilol • First line drug therapy. 2/1/2019 4
  5. 5. • Mechanism of Action: Disaccharides → monosaccharides → volatile fatty acid (VFA) + H ions. VFA : promotes bacterial growth, which form bulk. H ions: decrease pH which causes; 1. ↓ synthesis & absorption of ammonia. 2. ↑movement of ammonia from blood to GIT. 2/1/2019 5
  6. 6. • Dose: 15- 30 ml given twice a day to induce 2-3 soft bowel movements daily. Can be given as rectal enema. • Adverse effects: Bloating, hypokalemia, aspiration and dehydration. 2/1/2019 6
  7. 7. Antibiotics - Rifaximin • MOA: Selectively eliminates urease producing bacteria. • It is given in combination with lactulose. • Dose: 550mg/ 12hr. • AE: abdominal pain, flatulence, headache and constipation. • Other antibiotics like Metronidazole and Neomycin can also be used. 2/1/2019 7
  8. 8. Oral branched-chain amino acids (BCCAs) • Increase the manifestations of episodic HE. • Leucine → stimulate liver regeneration. • They increase albumin synthesis and improve immunity. 2/1/2019 8
  9. 9. L- ornithine L- aspartate (LOLA) • Can be given IV (preferred) or oral. • They help in detoxification of ammonia by promoting metabolic pathways and urea cycle. 2/1/2019 9
  10. 10. Zinc supplementation • Zn deficiency is common in patients with liver cirrhosis. • Zinc increases the activity of an enzyme in the urea cycle (ornithine transcarbamylase). And hence helps in improvement of HE. 2/1/2019 10
  11. 11. Other ammonia lowering agents • Probiotics • Sodium benzoate • Glycerol phenyl butyrate 2/1/2019 11
  12. 12. • Approximately 75% of patients with HE suffer moderate to severe protein-calorie malnutrition. • So, vegetable proteins should be given (60- 80g/day). They are well tolerated than animal proteins. • High glucose diet (35-40kcal/kg wght.). 2/1/2019 12 Nutrition
  13. 13. Liver transplantation • Recommended in recurrent HE and treatment resistant cases. • It results in complete resolution of HE. 2/1/2019 13
  14. 14. Prophylaxis  Combined Lactulose and Rifaximin should be used. 2/1/2019 14
  15. 15. References • Harrison’s Principles of Internal Medicine. • Davidson’s Principles and Practice of Medicine. 2/1/2019 15
  16. 16. 2/1/2019 16

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