Which of the following is not a pa of management of hepatic encephalopathy?
Correct Answer: Restriction of dietary protein
Description: In the past, restriction of dietary protein was considered for patients with encephalopathy; however, the negative impact of that manoeuvre on overall nutrition is thought to outweigh the benefit when treating encephalopathy, and it is thus discouragedHydration and correction of electrolyte imbalance are all that is necessaryThe mainstay of treatment for encephalopathy, in addition to correcting precipitating factors, is to use lactulose, a nonabsorbable disaccharide, which results in colonic acidification. Catharsis ensues, contributing to the elimination of nitrogenous products in the gut that is responsible for the development of encephalopathy.Poorly absorbed antibiotics are often used as adjunctive therapies for patients who have had a difficult time with lactulose. The alternating administration of neomycin and metronidazole has commonly been used to reduce the individual side effects of each: neomycin for renal insufficiency and ototoxicity and metronidazole for peripheral neuropathy. More recently, rifaximin at 550 mg twice daily has been very effective in treating encephalopathy without the known side effects of neomycin or metronidazole.Zinc supplementation is sometimes helpful in patients with encephalopathy and is relatively harmlessRef: Harrison 19e pg: 2066
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