title: Neostigmine for the treatment of acute hepatic encephalopathy with acute intestinal pseudo-obstruction in a cirrhotic patient.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Park
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Joo
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Choi
authors.forename: Jong Sun
authors.initials: JS
authors.lastname: Rew
authors.forename: Sei Jong
authors.initials: SJ
authors.lastname: Kim
mesh_terms: 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
chemical_list: D002800:Cholinesterase Inhibitors; D004573:Electrolytes; D009388:Neostigmine; D011092:Polyethylene Glycols; D007792:Lactulose; D000641:Ammonia
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