How Do I Diagnose and Manage Acute Hepatic Encephalopathy?
Hepatic encephalopathy (HE) is a state of cerebral dysfunction due to accumulated ammonia and other toxins in patients with underlying liver insufficiency and/or portosystemic shunting. The diagnosis is largely clinical, but the differential is extensive. Broad diagnostic testing is necessary to exclude alternative etiologies. Asterixis is a classic finding, but is not pathognomonic. Serum ammonia concentrations do not correlate well with disease severity. Providers should strongly consider cerebral edema and intracranial hypertension. Lactulose and rifaximin comprise first-line treatment, but identification and correction of precipitating factors are essential.
KeywordsHepatic encephalopathy Cirrhosis Hyperammonemia Cerebral edema Lactulose Rifaximin
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