Treatment includes the discontinuation and avoidance of all sedatives, tranquilizers, and pain medications; discontinuation or reduction in the dosage of all diuretics; treatment of infection (particularly SBP); elimination of constipation; control of gastrointestinal bleeding; and reduction in amount, or total elimination of, animal protein from the diet. Some liver experts believe that strict vegetarian diets can help improve encephalopathy.（Further management involves oral administration of an antibiotic, （如果新的药物 Xifaxan ( rifaximin) 不知道，就的药物也应该知道）most commonly neomycin (4-6 grams per day). Since bacteria that naturally live in the intestines produce ammonia, and since ammonia has been linked to encephalopathy, treatment with neomycin (which reduces bacteria) should improve encephalopathy. Neomycin should not be used in people who have renal (kidney) failure, as it can be toxic to the kidneys. Metronidazole (Flagyl) at a dose of 800 mg/day taken for a period of one week, may be used as an alternative to neomycin. People found to have Helicobacter pylori in their stomachs must be treated with antibiotics and a proton-pump inhibitor（提到的PPI） – such as Prevacid. Since this bacteria produces urease (an enzyme needed to produce ammonia), it may have a role in precipitating encephalopathy. Lactulose is a very sweet, synthetic sugar that acts as a powerful laxative. It acidifies the stool and thereby traps ammonia and drags it out of the body along with other fecal material. Therefore, lactulose can be quite useful in the management of encephalopathy. Kristolose (manufactured by Cumberland Pharmaceuticals), is a crystalline form of lactulose. It is not as sweet tasting and syrupy in texture as lactulose and is thus more palatable to some people than lactulose. The dose for either lactulose or kristolose ranges from 30-60 grams per day. The goal is for the patient to have 2-4 loose bowel movements per day. Once the initial bout of encephalopathy has been overcome, maintenance with lactulose should continue with a goal of 1-2 loose bowel movements per day.
Zinc levels should be checked and supplemented if found to be deficient, as zinc deficiency may be a contributing factor to encephalopathy. Thiamine deficiency should also be considered, and supplements should be routinely administered if the patient has a known history of alcoholic liver disease. Administration of branched-chain amino acids (leucine, isoleucine, and valine) may have some benefit; however, evidence supporting this is inconclusive. Two other drugs, flumazenil and bromocriptine, may be useful in the treatment of encephalopathy, although further study is needed to confirm this. Fortunately, if the precipitating factor is promptly corrected and if treatment with lactulose is expeditiously started, encephalopathy, in most cases, will be reversed—at least on a temporary basis. Liver dialysis should be considered if encephalopathy does not improve despite the use of conventional medical treatments. Liver dialysis is analogous to kidney dialysis. A catheter is inserted into a vein in the patient. Some blood is removed through the catheter and is passed through the liver dialysis unit. In liver dialysis, toxins such as ammonia - which may cause encephalopathy, are removed from the patient’s blood. Then, the newly cleaned blood is returned to the patient through the same catheter. It takes about 4-6 hours to clear the blood of potential toxins that may cause encephalopathy. The HemoTherapies Unit is currently the only FDA- approved liver dialysis device in the United States. Many other devices are in the process of being developed. In any case, people with encephalopathy should be evaluated for a liver transplant.
楼主: Artemisia
发表于 2006-5-14 08:21
