Principle Hepatic Encephalopathy Lactulose

Normally: liver is the detox organ that converts ammonia to Urea that is eventually excreted in kidney.

Liver damage: (Cirrhosis, etc)

Liver is unable to convert ammonia to harmless Urea. Ammonia accumulates, goes through to the brain, penetrates the blood brain barrier and causes encephalopathy

Presentation

confusion & asterixis

Treatment: Lactulose

Lactulose is a diasaccharide –> acidifies colonic content –> absorbable ammonia to non absorbable ammonium ions –> excreted/trapped in stool –> fecal nitrogen excretion Increase

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contributer: sheeba tauhid imran