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20 May 2003 : Original article  

The conservative management of encephalopathy and hepatic coma

T. Hermanowska-Szpakowicz, J. H. Zajkowska, S. Grygorczuk, M. Kondrusik, S. A. Pancewicz

Med Sci Monit 2003; 9(2): 68-71 :: ID: 15325

Abstract

The main etiologic agents that play crucial role in development of hepatic encephalopathy are hepatotropic viral infections:HBV,HCV,HDV,HEV and rarely HAV.The other factors of importance are EBV,CMV,HSV,1,2 infections as well as drugs: paracetaminophenon, cyclofosfamid, imipramin, isoniazyd, estrogens, opioids. Among toxins which may cause hepatic encephalopathy are alcohol, chemical and mushroom intoxications (Ammanita phalloides).The aim of treatment is to recognise and eliminate the precipitating factors,elimination of nitrate substances which may cross from intestines to blood.In the treatment of hepatic encephalopathy low-protein diet are used.To eliminate ammonia and ammonia-producing bacteria from intestines lactulose,antibiotics and aspargin ornitate are used.To improve neurotransmitter synthesis branched-chain amino acid, flumazenil, bromocryptin may be used. Hemodialysis, hemofiltration and plasmapheresis early included may be benephicial in the treatment of hepatic encephalopathy.

Keywords: hepatic encephalopathy, Hepatitis, hepatic coma, Ammonia, dyalisis

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750