Treatment: Hepatic Encephalopathy

Remove precipitants; correct electrolyte imbalances. Lactulose (nonabsorbable disaccharide) results in colonic acidification and diarrhea and is the mainstay of treatment; goal is to produce 2-3 soft stools per day. Poorly absorbed antibiotics are often used in pts who do not tolerate lactulose, with alternating administration of neomycin and metronidazole being used to reduce the individual side effects of each. Rifaximin has recently also been used; zinc supplementation is sometimes helpful. Liver transplantation when otherwise indicated.

For a more detailed discussion, see Bacon BR: Cirrhosis and Its Complications, Chap. 365, p. 2058; in HPIM-19.