Management of Hepatic Encephalopathy

Table 1

Treatment stratagems used in HE.

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HE grade: I-II

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General management

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Hyperammonemia

Dietary protein supplementation

Purgatives

 (i) Nonabsorbable disaccharides

 (ii) Enemas

Non-absorbable antibiotics

Modulation of interorgan ammonia

 (i) L-ornithine, L-aspartate (LOLA)

 (ii) Sodium benzoate

 (iii) Phenylacetate

Others

 (i) Flumazenil “Bromocriptine” acarbose

Emerging therapies

 (i) Probiotics

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HE grade: III-IV

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Cerebral edema & elevated ICP

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General

 (i) Ventilate

 (ii) Sedate (e.g., Propofol)

Specific

 (i) Antimicrobials

 (ii) Hypertonic saline

 (iii) Mannitol

 (iv) Dexamethasone

 (v) Induced hypothermia

 (vi) Thiopentone

 (vii) Indomethacin

 (viii) Antiepileptic drugs (AED’S)

 (ix) N-acetylcysteine (NAC)

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Transplantation

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 Orthotopic liver transplant (OLT)

 Partial hepatectomy

 Liver assist devices

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