天津医科大学内科学课件 Hepatic Encephalopathy.pptVIP

Ⅶ. Treatment Principles: General and supportive measure. Methods designed to reduce blood ammonia levels. Measures to correct the abnormal amino and profile and accumulation of false neurotransmitters. 1. General and supportive measures. The precipitating causes in all cases of encephalopathy can be identified. Removal or correction of these inciting factors often leads to gratifying reversal of encephalopathy. 2. Azotemia (氮质血症) Azotemia is the most common discomfort. The case was by excessive diuresis. Gastrointestinal urea increases in azotemia from renal failure or from hypovolemia (due to gastrointestinal hemorrhage, excessive paracentesis, or overdiuresis), and is hydrolyzed to ammonia by intestinal bacteria. Avoiding excessive diuresis. Giving the diuretic agent on alternate days (or less frequently). Drug like metronidazole and ampicillin may be preferable to neomycin. An alternation is to use lactose 3. Misuse of CNS Depressant Drags Another precipitant of encephalopathy is the administration of sedative and analgesic drugs may be hinged in persons with hepatic dysfunction and such patients may be affected by these agents more readily, clinicians should be cautions in using these type of drugs dose should be adjusted according to the clinical response and by assay acceding to the clinical response and by assay of plasma drug levels. 4. Contral of Gastrointestinal Bleeding. Bleeding may lead to shock and hypoxia, blood in the gastrointestinal treat also server as an excellent substrate for the generation of ammonia. The administration of neomycin or lactulose is often recommended to prevent coma. 5. pH and Electrolyte Disturbance. Disturbance in acid-base and electrolyte balance is often happen. Metabolic alkaloses may follow vomiting, administration of diuretic. This alkaloses of this type is frequently associated with hypokalemia and hypochloremia. Treatment : potassinm chloride. Acidosis is less common than alkalosis in chronic hepatic decompensation.