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Beyond Lactulose

Treatment Options for Hepatic Encephalopathy

Said, Vickey J. MSN, AGACNP-BC; Garcia-Trujillo, Edith MSN, ACNP-BC

doi: 10.1097/SGA.0000000000000376
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Hepatic encephalopathy is a complication of liver failure characterized by neuropsychiatric dysfunction ranging from disorientation to coma. There is a need for more treatment options and preventive care interventions to reduce the incidence of hepatic encephalopathy and mitigate its socioeconomic impact on families and strain on healthcare resources. Currently, there is no consensus on a single pathophysiological mechanism responsible for the development of this neurocognitive disorder. Ammonia toxicity remains a significant factor, but there is now increased recognition that hyperammonemia acts synergistically with systemic inflammation, oxidative stress, and gut microbiota imbalance in the development of hepatic encephalopathy. This article provides an overview of current and emerging therapies that target these factors in the treatment and management of this condition. Because of its complex pathogenesis, a multipronged approach to treating hepatic encephalopathy may be highly beneficial.

Vickey J. Said, MSN, AGACNP-BC, is New Graduate, Adult-Gerontology Acute Care Nurse Practitioner Program, California State University, Los Angeles; and Nurse Practitioner, Neurosurgery Unit, Ronald Reagan UCLA Medical Center, Los Angeles, California.

Edith Garcia-Trujillo, MSN, ACNP-BC, is Clinical Instructor, Adult-Gerontology Acute Care Nurse Practitioner Program, California State University, Los Angeles; and Nurse Practitioner, Liver Transplant Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California.

Correspondence to: Vickey J. Said, MSN, AGACNP-BC, California State University, Los Angeles, School of Nursing, 5151 State University Dr, Los Angeles, CA, 90032 (vsaid@calstatela.edu).

The authors declare no conflicts of interest.

Received February 28, 2017

Accepted July 22, 2017

© 2019 by the Society of Gastroenterology Nurses and Associates, Inc.