What is the primary medical treatment for hepatic encephalopathy?

In the management of hepatic encephalopathy, decreasing protein intake and administering lactulose is a key therapeutic approach. Hepatic encephalopathy occurs due to the accumulation of toxins, particularly ammonia, in the bloodstream, which results from liver dysfunction.

Lactulose is a non-absorbable disaccharide that acts by altering colonic pH and facilitating the conversion of ammonia to ammonium, which is less readily absorbed. This mechanism helps to reduce the overall ammonia level in the body. Furthermore, lactulose promotes the production of organic acids in the colon, which can further facilitate the trapping of ammonia and enhance its elimination.

Decreasing protein intake is also essential because dietary proteins can increase ammonia production during their metabolism. In patients with liver disease, the liver is less capable of processing these proteins effectively, leading to higher ammonia levels. Therefore, a controlled protein intake, particularly focusing on high-quality, plant-based protein sources, can help manage and mitigate the effects of hepatic encephalopathy.

In summary, the rationale behind decreasing protein intake and administering lactulose is to reduce ammonia levels in the body and help alleviate the symptoms of hepatic encephalopathy, making this combination an effective primary treatment for the condition.