What is the primary treatment for hepatic encephalopathy?

The primary treatment for hepatic encephalopathy is lactulose combined with a low-protein diet. Lactulose is a non-absorbable disaccharide that helps to reduce ammonia levels in the gut. It does this by acidifying the colon, which promotes the conversion of ammonia (NH3) into ammonium (NH4+), a form that is less readily absorbed into the bloodstream. Moreover, lactulose acts as an osmotic laxative, which helps to increase the frequency of bowel movements, further facilitating the elimination of ammonia from the body.

In addition to lactulose, dietary management is crucial in the treatment of hepatic encephalopathy. A low-protein diet can help decrease the overall production of ammonia, which is primarily derived from the breakdown of dietary protein. It is important to balance protein intake carefully, as entirely eliminating protein may lead to malnutrition, which can worsen liver function.

Other options, such as corticosteroids, antibiotics, and intravenous fluids, have roles in the management of specific conditions associated with liver disease but do not serve as primary treatments for hepatic encephalopathy. Corticosteroids are used for conditions like alcoholic hepatitis but are not first-line therapies for hepatic encephalopathy itself. Antibiotics may be used in cases