title: Diagnosis and Management of Hepatic Encephalopathy in Fulminant Hepatic Failure.
abstract: Hepatic encephalopathy (HE) is associated with cerebral edema (CE), increased intracranial pressure (ICP), and subsequent neurologic complications; it is the most important cause of morbidity and mortality in fulminant hepatic failure. The goal of therapy should be early diagnosis and treatment of HE with measures to reduce CE. A combination of clinical examination and diagnostic modalities can aid in prompt diagnosis. ICP monitoring and transcranial Doppler help diagnose and monitor response to treatment. Transfer to a transplant center and intensive care unit admission with airway management and reduction of CE with hypertonic saline, mannitol, hypothermia, and sedation are recommended as a bridge to liver transplantation.
authors.affiliation: Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 Seventh Avenue South, Birmingham, AL 35294-0012, USA. Electronic address: skodali@uabmc.edu.
authors.forename: Sudha
authors.initials: S
authors.lastname: Kodali
authors.affiliation: Department of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 Seventh Avenue South, Birmingham, AL 35294-0012, USA.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: McGuire
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D000641:Ammonia / Q000097:blood*; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016166:Free Radical Scavengers / Q000627:therapeutic use; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007427:Intracranial Pressure; D007792:Lactulose / Q000627:therapeutic use; D017114:Liver Failure, Acute / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D059906:Neuroimaging; D009483:Neuropsychological Tests; D018529:Nutritional Support; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin
chemical_list: D016166:Free Radical Scavengers; D005765:Gastrointestinal Agents; D012294:Rifamycins; D007792:Lactulose; D000641:Ammonia; D000078262:Rifaximin; D000111:Acetylcysteine
keywords: Ammonia; Fulminant hepatic failure; Hepatic encephalopathy; Hyperammonemia