Neostigmine for the treatment of acute hepatic encephalopathy with acute intestinal pseudo-obstruction in a cirrhotic patient.
We treated a 49-yr-old man with neostigmine, who had liver cirrhosis, acute hepatic encephalopathy, and acute intestinal pseudoobstruction. He was admitted in a state of hepatic confusion. On physical examination, the abdomen was distended; and bowel sound was absent. Plain abdomen film revealed multiple air-fluid levels and distention of bowel loops. Initially, we gave him lactulose enemas every 6 hr for one day without improvement in his mental state. Furthermore, he became to a state of coma. Therefore, we gave him 0.5 mg of neostigmine subcutaneously to improve his peristaltic movement, and 2 L of polyethylene glycol electrolyte solution through a nasogastric tube for 4 hr to reduce the production and absorption of gut-derived toxins of nitrogenous compounds. After these treatments, the venous ammonia level decreased to the normal range within 12 hr, and the coma disappeared after 2 days. We suggest that neostigmine may be one of the most effective treatments to initiate peristaltic movement and bowel cleansing in cirrhotic patients with acute hepatic encephalopathy and acute intestinal pseudoobstruction.
Park
Chang Hwan
CH
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Joo
Young Eun
YE
Kim
Hyun Soo
HS
Choi
Sung Kyu
SK
Rew
Jong Sun
JS
Kim
Sei Jong
SJ
D000388:Air; D000641:Ammonia / Q000378:metabolism; D001794:Blood Pressure; D002800:Cholinesterase Inhibitors / Q000494:pharmacology*; D004573:Electrolytes / Q000494:pharmacology; D004733:Enema; D005355:Fibrosis / Q000188:drug therapy*; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D007792:Lactulose / Q000494:pharmacology; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000494:pharmacology*; D010528:Peristalsis; D011092:Polyethylene Glycols / Q000494:pharmacology; D011859:Radiography; D013997:Time Factors
D002800:Cholinesterase Inhibitors; D004573:Electrolytes; D009388:Neostigmine; D011092:Polyethylene Glycols; D007792:Lactulose; D000641:Ammonia
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