HEPATIC ENCEPHALOPATHY

• Characterized by neuropsychiatric sx; all the way from subtle personality changes to focal neurologic signs to frank coma
• Associated with either acute or advanced chronic liver disease
• Treatment
  • Antibiotics often used; thought to work by reducing ammonia-producing colonic bacteria (e.g. neomycin, ribostamycin, vancomycin, or rifaximin)
  • Lactulose, to acidify the colonic lumen and reduce ammonia absorption
    • Lactulose not found to be ass'd with significant improvement in encephalopathy sx or mortality in a meta-analysis of 22 randomized trials and ass'd with significantly worse changes in encephalopathy sx compared with antbiotics (BMJ 328:1046, 2004--JW)