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Old 09-22-2011
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Default Ccs: Hepatic encephalopathy

HEPATIC ENCEPHALOPATHY

pt presented with altered state of mind... had h/o of cirrhosis of liver already. was given oxycodone my dentist following which he devleloped symptoms..HEP C cirrhosis

LOOK FOR-alkalosisi,low k,SBP,HIGH PROT diet,
..

ER
routine (IV access, pulse oximetry, cont bp, cont cardiac moniter)
fingers stick glu
Thiamine inj
50% dxt

NGT suction (to look for variceal bleeding)
EKG
CXR
CBC, BMP, S.NH3
NPO
NSS

GPE( signs of cirrhosis, confused patient, asterixis)

LFT, PT, PTT, urine r/e, toxicology, blood alcohol level ,Mg
URINE culture
BLOOD culture
(pt marginally raised, lft deranged as for cirrhosis serum NH3 sky high)

admit ICU

urine output, bed rest, continue thiamine and dextrose normal saline drip,

propranolol to control portal HTN./ spironolactone

PARACENTESIS-SEND FLUID

LEVOFLOXACIN----IF PARACENT+VE{>250CELL) CHANGE TO CEFTRIAXONE

.Lactulose oral
[ampicillin po or neosporin po/ neomycin]
enemas to evacuate stool

Moniter PT/PTT/ cbc/bmp/ammo daily .

Pt improves
€“ADD diet salt restriction

.shift to wards in 24 hrs or when better

Case usually ends after 6 hrs of pt getting better.

rehab
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