hepatic encephalopathy
- related: GI gastroenterology
- tags: #literature #icu #GI
- confusion from liver insufficiency or porto-systemic shunting (bypassing liver)
- after tips: 10-50% of overt HE in 1 year
- overt: asterexis and/or disorientation
- ammonia not needed for diagnosis
- no ppx needed in pts who have never had HE
- precipitating factors
Differentiating between acute or chronic liver failure as etiology for hepatic encephalopathy is important because in acute liver failure, lactulose and rifaximin are not helpful (acute liver failure can cause cerebral edema and hepatic encephalopathy). In contrast, in acute on chronic liver failure, treatment includes both lactulose and rifaximin.
- treat lactulose with rifaximin together than lactulose alone 1