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Hepatic Encephalopathy

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A Condition Needing Medication and Monitoring

Hepatic encephalopathy is a serious condition that happens if the liver cannot do its job of removing toxins from the blood. These toxins include ammonia from the intestines. The buildup of toxins affects the brain’s ability to function.
The liver may not work as it should if it has a condition such as cirrhosis or portal hypertension.
Medication is used to prevent and treat hepatic encephalopathy. If left untreated or treated poorly, hepatic encephalopathy can lead to unresponsiveness, coma or death.
Use the information in this material to help understand:
• Symptoms and resulting restrictions of hepatic encephalopathy.
• Treatment of hepatic encephalopathy.
• Ways to lessen your risk of developing hepatic encephalopathy or making it worse.
It is important for you and those helping to care for you to know this information. If you have any questions, talk with your health care provider. He or she wants to answer your questions and help you get the best possible care.

A caregiver is important
It is important for your health and safety to have a family member or friend with you if you have hepatic encephalopathy symptoms. This person needs to help care for you and make sure you follow the treatment plan prescribed by your health care provider.
With hepatic encephalopathy, you may not always be aware of your symptoms. Having hepatic encephalopathy symptoms may prevent you from caring for yourself well enough. You may not always take your medications correctly, eat properly, or follow any other treatments. Knowing that you have a good caregiver can help bring you some peace of mind.

Other important considerations
Talk with your health care provider about completing a “Release of Information” form. This form says that your health care team can give your medical information to a family member or friend chosen by you. You need to update and sign this form every year.
If you have not already done so, you may want to complete a healthcare directive in which you appoint someone to act on your behalf for medical matters. Or you may want to assign someone to have power of attorney to make health care decisions if you cannot. Talk with a legal attorney about this.

Symptoms and Restrictions
Symptoms of hepatic encephalopathy include:
• Difficulty sleeping at night and excessive sleepiness or drowsiness during the day.
• Difficulty concentrating.
• Difficulty with coordination of mental or physical activities.
• Slurred speech.
• Confusion. This usually happens with more advanced hepatic encephalopathy.

If you have any of the symptoms of hepatic encephalopathy:
• You or the person caring for you should call your health care provider.
• Do not:
–– Drive. If you have a history of hepatic encephalopathy, do not drive. –– Make major financial decisions.
–– Take part in any activity that could harm you or others.
–– Take sedatives or narcotics, or drink alcohol. They can make symptoms worse.
If you become unresponsive, your caregiver should call 911 or your local emergency care response telephone number.

Preventing and Treating Hepatic Encephalopathy

Lactulose
Unless your health care provider tells you otherwise, preventing and treating hepatic encephalopathy requires drinking a medication called lactulose. This medication helps remove ammonia and other toxins from your intestines.
The goal is to take the right dose of lactulose as often as needed to cause you to have three soft, formed bowel movements every day. Your health care provider may instruct you to have more than three bowel movements every day.
Take lactulose as prescribed. However, as instructed by your health care team, increase or decrease how often you take lactulose and/or how much you take (dose), so that you have only the number of soft, formed bowel movements you were told to have. Once you have this many bowel movements in a day, stop taking lactulose for the rest of the day.
If you take more lactulose than you need or take it too often, you could have more bowels movements than your health care provider wants you to have, or have diarrhea. This can put you at risk for dehydration and worse hepatic encephalopathy symptoms.
If you have loose stools or diarrhea for 72 hours, even after stopping lactulose, contact your health care provider.
Many people mix lactulose with chocolate milk to make it taste better. Common side effects of lactulose include nausea and bloating.
Your health care team wants to make sure you understand how to take your medication correctly. If you have questions about taking lactulose, or if the taste or side effects are bothersome to you, contact a member of your health care team.

Rifaximin
Your health care provider may recommend that you take the medication rifaximin. This is an antibiotic that changes bacteria flora in your intestines to lessen how much ammonia is made.
Rifaximin is more expensive than lactulose. The cost may not be covered by insurance.

Lessen Your Risk
The following are ways you can lessen your risk of developing hepatic encephalopathy or making it worse.

Health issues
Sometimes hepatic encephalopathy can be triggered by a urinary tract infection or other infection, gastrointestinal bleeding, medication issues or other factors. It is important to monitor your health and to contact your health care team when you have concerns or questions.
Follow your schedule for any blood tests and medical examinations.

Medications
Take only the medications prescribed for you. Talk with your health care provider before you take any other medications, vitamins or supplements.
Do not take narcotics or benzodiazepines. These medications affect the brain which can worsen hepatic encephalopathy symptoms.
Do not take ibuprofen, aspirin, or products that have aspirin in them unless you are told otherwise by your health care provider.

Nutrition
Your health care provider may recommend that you make changes to what you eat and drink.
It is important to eat enough protein to maintain muscle mass. It is recommended that every day you eat about 1 to 1.5 grams of protein for every kilogram you weigh.
One kilogram is equal to 2.2 pounds. To determine how many kilograms you weigh:
–– Divide your weight by 2.2. For example: If you weigh 160 pounds, divide 160 by 2.2. This equals 72.7. Therefore, 72.7 kilograms is equal to 160 pounds.
To determine how many grams of protein to eat every day:
–– Multiply your weight in kilograms by 1 or 1.5. For example: If you weigh 72.7
kilograms, multiple 72.7 by 1 or 1.5. This gives you the range of 72.7 to 109 grams of protein.
Your health care provider or dietitian can instruct you on the amount of protein that is right for you.
Alcohol
Do not drink alcohol. Even a single glass of alcohol can damage your liver further.
Alcohol can make hepatic encephalopathy symptoms worse.

Contacting Your Health Care Provider
If you have questions after reading this material, call the appropriate Midas Hospital telephone number and ask to talk with your health care provider.