Hepatic Encephalopathy 61
BUY
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powder (Promix) may be added to each 500 cc of solution. Flush tube with
100 cc water q8h.
Special Medications:
-Metoclopramide (Reglan) 10-20 mg PO or in J-tube q6h OR
-Cisapride (Propulsid) 10-20 mg via nasogastric tube qid (concurrent use with
macrolide antibiotics or azole antifungals may result in prolongation of QT
interval) OR
-Erythromycin 125 mg IV or via nasogastric tube q8h.
-Cimetidine (Tagamet) 400 mg PO bid OR
-Ranitidine (Zantac)150 mg PO bid.
Symptomatic Medications:
-Loperamide (Imodium) 2-4 mg PO/J-tube q6h prn, max 16 mg/d OR
-Diphenoxylate/atropine (Lomotil) 1-2 tabs or 5-10 mL (2.5 mg/5 mL) PO/J-
tube q4-6h prn, max 12 tabs/d OR
-Kaopectate 30 cc PO or in J-tube q8h.
Extras: CXR, plain abdominal x-ray for tube placement, nutrition consult.
Labs:
Daily labs: SMA7, osmolality, CBC, cholesterol, triglyceride. SMA-12
Weekly Labs when indicated: Protein, Mg, INR/PTT, 24h urine nitrogen and
creatinine. Pre-albumin, retinol-binding protein.
Hepatic Encephalopathy
1. Admit to:
2. Diagnosis: Hepatic encephalopathy
3. Condition:
4. Vital signs: q1-4h, neurochecks q4h. Call physician if BP >160/90,<90/60;
P >120,<50; R>25,<10; T >38.5
C
5. Allergies: Avoid sedatives, NSAIDS or hepatotoxic drugs.
6. Activity: Bed rest.
7. Nursing: Keep head-of-bed at 40 degrees, guaiac stools; turn patient q2h
while awake, chart stools. Seizure precautions, egg crate mattress, soft
restraints prn. Record inputs and outputs.
8. Diet: Low protein nasogastric enteral feedings (Hepatic-Aid II) at 30 mL/hr.
Increase rate by 25-50 mL/hr at 24 hr intervals as tolerated until final rate of
50-100 mL/hr as tolerated. No dietary protein for 8 hours.
9. IV Fluids: D5W at TKO, Foley to closed drainage.
10.Special Medications:
-Sorbitol 500 mL in 200 mL of water PO now.
-Lactulose 30-45 mL PO q1h for 3 doses, then 15-45 mL PO bid-qid, titrate to
produce 3 soft stools/d OR
-Lactulose enema 300 mL in 700 mL of tap water; instill 200-250 mL per rectal
tube bid-qid. AND
-Neomycin 1 gm PO q4-6h (4-12 g/d) OR
-Metronidazole (Flagyl) 250 mg PO q6h.
-Ranitidine (Zantac) 50 mg IV q8h or 150 mg PO bid OR
