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The Nurse Practitioner

July 2011, Volume 36 Number 7 , p 8 - 9


  • Jennifer M. Belavic PharmD, FASCP


Hepatic encephalopathy (HE) is responsible for an average of 50,000 hospitalizations of approximately5.5 million individuals with liver cirrhosis every year.1 HE is a reversible complication of liver failure that causes neuropsychiatric problems.2-4 HE patients experience neurologic changes related to cognitive, psychiatric, and motor impairment.1 This impairment can be accompanied by a number of symptoms including decreased mental status, memory impairment, sensory changes, lack of concentration, disorientation, and coma.2The exact cause of HE in patients with liver cirrhosis is unknown. However, the general consensus is that these individuals are unable to remove toxic substances, especially from ammonia-producing bacteria, from the gut via the liver. Therefore, treatment is focused on decreasing the production of these ammonia-producing bacteria, as episodes occur.The oral antibiotics neomycin, vancomycin, and metronidazole have been used for many years. However, the most commonly used

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