▶️HE is horrible, unpredictable
▶️Preventing HE is hard
▶️Dont be quick 2 label pts as 'noncompliant' - there's more to the story
▶️Our patients are awesome. Hepatology is the best
The answer is that colonic bacteria metabolize the lactulose, spitting out organic acids
Check out this study from @jclinicalinvest comparing the stool output and organic acid concentration after PEG (aka golytely) vs lactulose
Even in subjects who had formed stool, lactulose still increased the organic acid concentration!
When a pt comes in with acute CHF, would we give them their home diuretic dose?
Patients admitted with HE often get ~10-20cc TID
🔥Hot take 🔥 This is not enough: That is a maintenance dose
Your pt needs an induction dose!
I learned how 2 treat HE from nurses when I was an intern. We took what they were doing & standardized treatment for HE. Some extra, frequent doses make a big difference(Fig1)
- Hepatology = the best
- Do that para! Search 4 HE triggers
- Drop that stool pH! Even a little lactulose helps
- Laxation now!! Need frequent BMs on Day 0-1 to treat Overt HE. Take your pick: extra doses of lactulose or lactulose + PEG.
Thanks for stopping by!