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Housestaff Survival Guide | Specialty | Hepatic encephalopathy
Suspect hepatic encephalopathy on patients with liver disease and mental status changes. Hepatic Encephalopathy is a range of
neuropsychiatric abnormalities in patients with compromised liver function. Multiple pathways contribute to this disorder. It is importnat to
r/o other causes of altered mental status and proceed with treatment.
Management
- RULE OUT OTHER CAUSES AND ASSESS FOR PRECIPITATING CAUSES
- Initiate infectious workup
- Assess for other causes of mental status changes
- Assess if patient can protect airway (gag reflex?)
- Lactulose (via NG tube, Oral if alert/awake, or rectal)
- 30-45 mL (20 g/30 mL) orally 3-4 times daily; adjust every 1-2 days to achieve 2-3 soft formed stools/day OR 300 mL (200 g) in 700
mL of water or saline rectally as a retention enema every 4-6 hours as needed; retain enema for 30-60 minutes
- Rifaximin 200mg Orally
• HE calculator
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