Treatment of hepatic encephalopathy

If you have hepatic encephalopathy, you should receive good treatment in time. First of all, you need to adjust the patient's diet structure, supplement enough protein, and have a low-salt, high-vitamin diet. In addition, when using sedatives, you must follow the doctor's advice to avoid worsening the condition. In addition, you must correct the patient's electrolyte and acid-base balance in time. If there is bleeding, you should stop the bleeding in time.

Treatment of hepatic encephalopathy

(1) Adjusting dietary structure

Patients with cirrhosis often have a negative nitrogen balance, so they should supplement with adequate protein. However, a high-protein diet can induce hepatic encephalopathy, so patients with hepatic encephalopathy should limit protein intake and ensure heat supply. Patients in stages III-IV should not supplement protein from the gastrointestinal tract, but can receive nasogastric feeding or intravenous injection of 25% glucose solution. Patients in stages I-II should limit their protein intake to 20 g/day. If their condition improves, 10 g of protein can be added every 3 to 5 days to gradually increase the patient's tolerance to protein. After the patient has fully recovered, he or she can consume 0.8 to 1.0 grams of protein per kilogram of body weight per day to maintain basic nitrogen balance. Because plant protein (such as soy products) is rich in branched-chain amino acids and non-absorbable fiber, the latter can promote intestinal peristalsis and, after being broken down by bacteria, can lower the pH value of the colon, thereby accelerating the excretion of toxins and reducing ammonia absorption. Therefore, plant protein should be the first choice for patients with hepatic encephalopathy. Dairy products are rich in nutrients and can be consumed in moderation if the condition is stable.

(2) Use sedatives with caution

Barbiturates and benzodiazepines can activate GABA/BZ complex receptors. In addition, due to decreased liver function in patients with cirrhosis, the half-life of drugs is prolonged. Therefore, the use of these drugs may induce or aggravate hepatic encephalopathy. If the patient develops mania, these drugs should be banned and antihistamines such as promethazine and chlorpheniramine (chlorpheniramine) should be tried instead.

(3) Correct electrolyte and acid-base imbalance

Patients with cirrhosis may suffer from hypokalemic alkali poisoning due to small food intake, excessive diuresis, and large amounts of diarrhea, which may induce or aggravate hepatic encephalopathy. Therefore, the dosage of diuretics should not be too large. When a large amount of ascites is discharged, sufficient albumin should be intravenously infused to maintain effective blood volume and prevent electrolyte imbalance. Patients with hepatic encephalopathy should regularly test serum electrolytes and blood gas analysis, and any hypokalemia or alkali poisoning should be corrected promptly.

(4) Stop bleeding and clear intestinal blood

Upper gastrointestinal bleeding is an important cause of hepatic encephalopathy. Therefore, patients with esophageal varicose vein bleeding should take various emergency measures to stop bleeding and transfuse blood products to replenish blood volume. The following measures can be taken to clear intestinal blood: oral or nasogastric administration of lactulose, sorbitol solution or 25% magnesium sulfate, enema with normal saline or weak acid (such as acetic acid), and enema with lactulose diluted to 33.3%.