Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Ceftriaxone
7%
1/15
Dextrose
20%
3/15
Lactulose
40%
6/15
Potassium
27%
4/15
Rifaximin
Select Answer to see Preferred Response
This patient is suffering from hepatic encephalopathy secondary to cirrhosis given his asterixis and confusion. The patient has hypokalemia as well and should have this electrolyte abnormality repleted first prior to administering any agents that could worsen electrolyte abnormalities. Hepatic encephalopathy is a decline in mental status secondary to liver failure. It occurs when the liver is unable to clear the blood of toxic metabolites, in particular, ammonia. Hypokalemia and a metabolic alkalosis are 2 derangements that can precipitate hepatic encephalopathy. Other precipitating factors include the use of sedative or CNS-altering drugs, infection, and hypovolemia. Potassium or any other electrolyte derangements must be repleted immediately prior to giving any medications that could worsen an electrolyte abnormality (such as lactulose). Once the patient's electrolytes have been repleted and their volume status is stable, medications such as lactulose or rifaximin can be given to treat hepatic encephalopathy. Incorrect Answers: Answer 1: Ceftriaxone would be indicated for spontaneous bacterial peritonitis which presents with a distended, tender abdomen and a fever. Paracentesis and culture would be performed prior to giving antibiotics. Answer 2: Dextrose must be repleted in this hypoglycemic patient; however, he must first have his potassium repleted as dextrose administration could cause endogenous insulin release further worsening hypokalemia and potentially causing fatal arrhythmias. Answer 3: Lactulose is used to treat hepatic encephalopathy; however, it also causes diarrhea and can cause dehydration and worsen this patient's hypokalemia. It should be administered after electrolyte repletion. Answer 4: Rifaximin is an antibiotic that is used to treat hepatic encephalopathy. It kills bowel flora to reduce the production of ammonia. However, the patient's underlying hypokalemia must be treated first as this is a more life-threatening derangement than addressing increased ammonia production. Bullet Summary: Hepatic encephalopathy can be exacerbated by hypokalemia, and electrolyte replacement is the best initial step in management.
3.9
(11)
Please Login to add comment