Lactulose 20g PO or (300mL in 700cc H2O retention enema x30min)
In colon degrades into lactic acid: acidic environment traps ammonia
Also inhibits ammonia production in gut wall
In colon degrades into lactic acid: acidic environment traps ammonia
Also inhibits ammonia production in gut wall
Rifaximin is second line.
Some new evidence suggest use of PEG in patients who are not candidates for Lactulose.
Hepatic encephalopathy
Subdural Hematoma
Ethanol toxicity
Hypoglycemia
Methanol toxicity
Wernicke-Korsakoff Syndrome
Acute hepatitis
Hyper/hyponatremia