What is hepatic encephalopathy,”Liver unable to breakdown NH3 and thus it accumulates in the brainPresentation: Asterixis, hyperreflexia, musty breathTreat: Lactulose –> metabolized by colonic bacteria –> acidifes NH3 into NH4 –> poorly R by gut and thus E in stool. May also give neomycin to kill bowel flora and thus reduce bacterial production of NH3*Alkalosis, hypokalemia

What is hepatic encephalopathy,”Liver unable to breakdown NH3 and thus it accumulates in the brainPresentation: Asterixis, hyperreflexia, musty breathTreat: Lactulose –> metabolized by colonic bacteria –> acidifes NH3 into NH4 –> poorly R by gut and thus E in stool. May also give neomycin to kill bowel flora and thus reduce bacterial production of NH3*Alkalosis, hypokalemia

constipation can worsen/trigger episodes”