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World J Gastrointest Pharmacol Ther. Apr 6, 2010; 1(2): 54-63
Published online Apr 6, 2010. doi: 10.4292/wjgpt.v1.i2.54
Published online Apr 6, 2010. doi: 10.4292/wjgpt.v1.i2.54
General supportive care | |
Prevention of falls or body harm in disorientated patients | |
Care of bladder and bowel function | |
Care of i.v. lines | |
Monitor fluid balance | |
Monitor glycaemia and electrolytes | |
Monitor arterial blood gases | |
Correct acid/base disturbances | |
Monitor blood pressure | |
Avoid aspiration pneumonia | |
Prevent causes of sepsis | |
Support nutritional needs | An energy intake of 35-40 kcal /kg BW/d and a protein intake of 1.2-1.5 g/kg BW/d are recommended. Energy should be provided by glucose and fat in a ratio of 65-50: 35%-50% of non protein calories according to the ESPEN guidelines for nutrition in liver disease (31) In patients with severe hepatic encephalopathy (Grade III-IV), solutions with an increase content of BCAAs and reduced amount of aromatic amino acid can ameliorate neurological symptoms ensuring adequate protein intake |
Treatment of the precipitating event | |
GI bleeding | Stop bleeding with vasoactive drugs, endoscopic therapy or angiographic shunt (TIPS) Correct anaemia with blood transfusion Nasogastric tube to facilitate upper GI cleansing |
Infection (pulmonary, urinary tract, spontaneous bacterial peritonitis) | Appropriate antibiotic terapie |
Exogenous sedatives | Discontinue benzodiazepines |
Electrolyte abnormalities | Discontinue diuretics Correct hypo or hyperkalemia |
Constipation | Cathartic Bowel enema |
Deterioration of renal function | Discontinue diuretics Correct dehydration Discontinue nephrotoxic antibiotics |
- Citation: Riggio O, Ridola L, Pasquale C. Hepatic encephalopathy therapy: An overview. World J Gastrointest Pharmacol Ther 2010; 1(2): 54-63
- URL: https://www.wjgnet.com/2150-5349/full/v1/i2/54.htm
- DOI: https://dx.doi.org/10.4292/wjgpt.v1.i2.54