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Sweat Puddled, Brains Muddled

Hepatic Encephalopathy

Heidi James, MD and Andrew Buelt, DO
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Tags gatroenteritis · pharmacology

Hepatic encephalopathy is a frequent neuropsychiatric complication of end stage liver disease caused by accumulation of ammonia and other neuro-toxins.  It begins with subtle symptoms including sleep disruption and progresses to confusion, disorientation and potentially coma. Three year mortality rates after hospital admission exceed 70%. Treatment is directed at removing ammonia through bowels movements; lactulose is the mainstay of treatment, with rifampin playing a role in refractory cases.

 

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Bob F. -

Do you mean rifaximin instead of rifampin?

Heidi J., MD -

You, sir, are correct!! Thanks for bringing that to our attention; fixing it right now.

Danielle K. -

brought me back to my hospital medicine days! Asterixis is really cool to see the first time-- it was one of those "omg that is what it looks like" moments for me!

Michelle M. -

Using miralax and lactulose together right now - yay for met enceph admits!

Heidi J., MD -

Fantastic! Is it working well?

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Sweat Puddled, Brains Muddled Full episode audio for MD edition 173:58 min - 82 MB - M4AHippo Primary Care RAP February 2017 Summary 316 KB - PDF