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The pathogenesis of hepatic encephalopathy has not been fully elucidated, but a large amount of information has shown that ammonia is an important mediator of hepatic encephalopathy.
Most current treatments are for the treatment of hyperammonemia, which is a feature of most hepatic encephalopathy.
The treatment principles of hepatic encephalopathy are roughly divided into four aspects: ➤ find and remove the inducement; ➤ reduce the production and absorption of ammonia and other toxins from the intestinal tract.
It includes a low-protein diet, changing the intestinal bacterial spectrum and colon environment (antibiotics, lactulose/lacitol), and stimulating intestinal emptying (intestinal washing); ➤ Proper nutritional support and maintaining water and electrolyte balance; ➤ According to the clinical type , Make personalized treatment plans for different causes and severity of diseases.
Removal of inducements Most hepatic encephalopathy/mild hepatic encephalopathy have certain predisposing factors, and after the predisposing factors are removed, hepatic encephalopathy/mild hepatic encephalopathy can often resolve spontaneously.
The causes of hepatic encephalopathy are: ➤ infection ➤ gastrointestinal bleeding ➤ electrolyte disturbance (hypovalence/alkaliosis) ➤ dehydration ➤ central nervous system active drugs ➤ constipation ➤ excessive protein intake ➤ not taking lactulose as prescribed ➤ uremia Symptoms ➤ Intestinal obstruction ➤ Used anesthetics ➤ Superinfected hepatitis ➤ Progression of hepatocellular carcinoma ➤ Portal decompression or TIPS surgery Some causes and solutions are as follows: Nutrition European Society for Enteral and Parenteral Nutrition (ESPEN) Guidelines The recommended non-protein energy intake for patients with hepatic encephalopathy grade 1 and grade 2 is 104.
6-146.
4 kJ/kg/d; the initial protein intake is 0.
5 g/kg/d, and then gradually increased to 1.
0-1.
5 g/kg /d.
If the patient is intolerant to animal protein, branched-chain amino acids and plant protein can be supplemented appropriately.
For patients with hepatic encephalopathy grades 3 and 4, the recommended non-protein energy intake is 104.
6-146.
4 kJ/kg/d, and the protein intake is 0.
5-1.
2 g/kg/d.Patients with hepatic encephalopathy prefer enteral nutrition.
If parenteral nutrition is necessary, it is recommended that fat supply accounts for 35%-50% of non-protein energy, and the rest is provided by carbohydrates.
It requires more protein (1.
2 g/kg/d) to maintain a positive nitrogen balance in patients with liver cirrhosis, so it is not possible to limit protein in these patients for a long time.
Therapeutic drugs and other auxiliary treatment methods The non-biological artificial liver methods currently used clinically to assist the treatment of hepatic encephalopathy mainly include: plasma exchange, hemoperfusion, hemofiltration, hemofiltration dialysis (HDF), plasma filtration dialysis (PDF) , Molecular Adsorption Recirculation System (MARS), partial plasma separation and adsorption system, etc.
References: [1] Chinese Medical Association Gastroenterology Branch, Chinese Medical Association Hepatology Branch.
Chinese Consensus on Diagnosis and Treatment of Hepatic Encephalopathy (2013, Chongqing) [J].
Chinese Journal of Digestion, 2013, 33(9).
[ 2] Wang Fusheng, et al.
Schiff's Hepatology (11th edition)[M].
Peking University Medical Press.
2015.
[3] Eugene R.
Schiff, Willis C.
Maddrey.
Michael F.
Scorell.
Schiff's Diseases of the Liver [M].
11th ed.
2012.
[4] Chatauret N, Butterworth RF.
Effects of liver failure on inter-organ trafficking of ammonia: implications for the treatment of hepatic encephalopathy [J].
J Gastroenterol Hepatol.
2004.
19: S219-223.
E-mail for submission: tougao@medlive.
cn
Most current treatments are for the treatment of hyperammonemia, which is a feature of most hepatic encephalopathy.
The treatment principles of hepatic encephalopathy are roughly divided into four aspects: ➤ find and remove the inducement; ➤ reduce the production and absorption of ammonia and other toxins from the intestinal tract.
It includes a low-protein diet, changing the intestinal bacterial spectrum and colon environment (antibiotics, lactulose/lacitol), and stimulating intestinal emptying (intestinal washing); ➤ Proper nutritional support and maintaining water and electrolyte balance; ➤ According to the clinical type , Make personalized treatment plans for different causes and severity of diseases.
Removal of inducements Most hepatic encephalopathy/mild hepatic encephalopathy have certain predisposing factors, and after the predisposing factors are removed, hepatic encephalopathy/mild hepatic encephalopathy can often resolve spontaneously.
The causes of hepatic encephalopathy are: ➤ infection ➤ gastrointestinal bleeding ➤ electrolyte disturbance (hypovalence/alkaliosis) ➤ dehydration ➤ central nervous system active drugs ➤ constipation ➤ excessive protein intake ➤ not taking lactulose as prescribed ➤ uremia Symptoms ➤ Intestinal obstruction ➤ Used anesthetics ➤ Superinfected hepatitis ➤ Progression of hepatocellular carcinoma ➤ Portal decompression or TIPS surgery Some causes and solutions are as follows: Nutrition European Society for Enteral and Parenteral Nutrition (ESPEN) Guidelines The recommended non-protein energy intake for patients with hepatic encephalopathy grade 1 and grade 2 is 104.
6-146.
4 kJ/kg/d; the initial protein intake is 0.
5 g/kg/d, and then gradually increased to 1.
0-1.
5 g/kg /d.
If the patient is intolerant to animal protein, branched-chain amino acids and plant protein can be supplemented appropriately.
For patients with hepatic encephalopathy grades 3 and 4, the recommended non-protein energy intake is 104.
6-146.
4 kJ/kg/d, and the protein intake is 0.
5-1.
2 g/kg/d.Patients with hepatic encephalopathy prefer enteral nutrition.
If parenteral nutrition is necessary, it is recommended that fat supply accounts for 35%-50% of non-protein energy, and the rest is provided by carbohydrates.
It requires more protein (1.
2 g/kg/d) to maintain a positive nitrogen balance in patients with liver cirrhosis, so it is not possible to limit protein in these patients for a long time.
Therapeutic drugs and other auxiliary treatment methods The non-biological artificial liver methods currently used clinically to assist the treatment of hepatic encephalopathy mainly include: plasma exchange, hemoperfusion, hemofiltration, hemofiltration dialysis (HDF), plasma filtration dialysis (PDF) , Molecular Adsorption Recirculation System (MARS), partial plasma separation and adsorption system, etc.
References: [1] Chinese Medical Association Gastroenterology Branch, Chinese Medical Association Hepatology Branch.
Chinese Consensus on Diagnosis and Treatment of Hepatic Encephalopathy (2013, Chongqing) [J].
Chinese Journal of Digestion, 2013, 33(9).
[ 2] Wang Fusheng, et al.
Schiff's Hepatology (11th edition)[M].
Peking University Medical Press.
2015.
[3] Eugene R.
Schiff, Willis C.
Maddrey.
Michael F.
Scorell.
Schiff's Diseases of the Liver [M].
11th ed.
2012.
[4] Chatauret N, Butterworth RF.
Effects of liver failure on inter-organ trafficking of ammonia: implications for the treatment of hepatic encephalopathy [J].
J Gastroenterol Hepatol.
2004.
19: S219-223.
E-mail for submission: tougao@medlive.
cn
