Lactulose Treatment and Hepatic Encephalopathy Symptoms

Hepatic encephalopathy symptoms often refer to changes in personality, mental state, and nervous system in people with liver failure. High levels of ammonia in the bloodstream and brain may be the cause. Bacteria in the stomach and intestines produce ammonia.

Usually, the liver metabolizes ammonia (making ammonia less harmful). However, people with liver disease have more ammonia because their liver is not functioning. Ammonia enters the blood, into the brain, and causes symptoms by interfering with brain function.

This encephalopathy occurs in more than 50% of people with cirrhosis of the liver. If left untreated, the disease may lead to coma and death, but is not contagious and cannot be inherited from parent to child.

Signs and Symptoms

The main symptoms of hepatic encephalopathy include confusion and dementia, drowsiness, and mood changes, lethargy, memory loss, and even coma. Other symptoms include jaundice, difficulty speaking, trembling, irritability and uncontrolled movements. In addition, patients usually have signs of liver disease, such as jaundice, enlarged breasts and testes shrink (men), fluid in the stomach, and legs swell.

Hepatic encephalopathy is divided into levels 1 to 4. Grade 1 includes mild confusion, inattention, irritability, and reduced ability to perform mental tasks. At level 2, people get sluggish, drowsy, personality changes, and more problematic in doing mental tasks. At level 3, they are sleepy (but get aroused), unable to do mental tasks, and confusion (place and time). At level 4, they are in a coma.

Some signs or symptoms may exist that are not listed above. If you feel anxious about the symptoms, consult a doctor. Call your doctor if you or your family members and relatives have any of the above symptoms, especially for those previously affected by liver disease.

This disease may grow rapidly and is very dangerous. Every human body acts different from each other. Discuss with your doctor to get the best solution for your condition.

 Cause

Abnormalities that damage the liver and cause liver failure can lead to hepatic encephalopathy. Some of these abnormalities are viral hepatitis (such as hepatitis B and hepatitis C), severe infections, autoimmune diseases, cancer, and Reye’s syndrome.

Other causes may be drugs such as non-steroidal anti-inflammatory drugs and toxins such as alcohol. People with cirrhosis may be exposed to encephalopathy from sedative and analgesic use. Certain factors may increase the risk of hepatic encephalopathy:

  1. Dehydration
  2. Eat too much protein
  3. Bleeding from the inside of the intestine, stomach, or esophagus
  4. Infection
  5. Kidney disorders
  6. Low oxygen levels in the body
  7. Drugs that suppress the central nervous system (e.g. barbiturates or benzodiazepines)
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 Lactulose Treatment For Hepatic Encephalopathy

Hepatic encephalopathy may be an emergency treatment that requires hospitalization. The goal of treatment is to find and treat causes, for example drugs, GI bleeding, and metabolic problems. If the specific cause is GI bleeding, it should be treated promptly.

The drug called lactulose acts as a laxative and helps to empty the intestines, so bacteria cannot make ammonia. Sometimes, antibiotics called neomycin are also used. This drug kills bacteria in the intestine so that the amount of ammonia is reduced.

Hepatic encephalopathy occurs when liver damage causes it to no longer filter toxins in the blood or when blood flow to the liver is inhibited. This can occur in both acute fulminant and chronic hepatitis. Increased levels of ammonia in the blood, is considered the main cause of this disorder. Other toxins that are also suspected to be associated are short chain fatty acids, and mercaptans.

Ammonia is a protein digestive product by bacteria in the gut. Normally, ammonia is metabolized by the liver into urea and excreted as urine. High ammonia in the blood alters the balance of neurotransmitters in the brain. This theory fits the circumstances in which the decreased ammonia levels improve the symptoms of encephalopathy.

Hepatic encephalopathy therapy aims to neutralize toxins, especially ammonia. The treatment that can be used is lactulose, a synthetic disaccharide not digested in the intestine. Lactulose is hydrolyzed intestinal bacteria into lactic acid and acetate.

This acidic environment ionizes ammonia into ammonium ions, so it does not diffuse through the colon membrane and will be excreted with the faeces. Lactulose also inhibits the formation of ammonia by intestinal bacteria.

Another advantage of lactulose is its cathartic nature. Lactulose will attract fluid to soften the feces and stimulate intestinal peristalsis. Increased intestinal peristaltic will shorten the transit time of feces in colon, so that less absorbed ammonia.

Giving antibiotics such as metronidazole and neomycin are also known to reduce levels of toxins because it suppresses bacteria in the intestine. However, long-term use is not recommended because of its side effects; considering that neomycin is both ototoxic and nephrotoxic. Antibiotics are usually used only when lactulose does not produce results.

Generally speaking lactulose inhibits the production and absorption of ammonia in the intestine, and increases its elimination through feces. Efficacy and safety of lactulose in the prevention of hepatic encephalopathy symptoms has been demonstrated by numerous studies.

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