| Symptoms
& History
Physical
Findings
Stop
& Think
Lab
and X-Ray
Differential
Diagnosis
The
Disease
Treatment
Conclusions
Quiz
& Evaluation |
|
More
of Mr. Weiser's treatment plan
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Hepatic
encephalopathy: Four basic approaches.
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Identify and treat underlying
cause: hepatitis, cirrhosis, GI bleed.
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Reduce and/or eliminate ammonia
substrate: gastritis and blood from varices, dietary protein restriction.
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Reduce colonic bacteria:
neomycin.
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Prevent absorption of ammonia:
Administer lactulose, bacteria metabolize it to organic acids, dropping
bowel pH. Lowered pH converts ammonia to non-absorbed form NH4+
Clearly, what we have to offer
Mr. Weiser is palliative and not curative. The outcome is obvious,
it's just a matter of when.
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