Health Management
One of the effects of End Stage Liver Disease is encephalopathy. When your body is unable to clear toxins through the liver because of its diseased state, the result is a change in mental function, including changes in mood, confusion, disorientation, and fatigue. Driving becomes difficult and dangerous.
The presence of encephalopathy is usually determined through a mental and physical exam. Although many different toxins may be involved, the most common one is ammonia. Therefore, a blood test for increased ammonia level is performed, as well as a test for decreased levels of zinc.
Treatment of encephalopathy involves medications and dietary recommendations. Medications include Neomycin, an antibiotic. Some antibiotics change the chemistry of the bacteria in the intestine and lowers the ammonia levels released into the bloodstream. If one is taking antibiotics for more than six months, especially along with Lasix (used for treatment of high blood pressure and other conditions that require the elimination of excess fluid from the body, such as congestive heart failure, cirrhosis of the liver, and kidney disease), hearing tests should be conducted, as hearing loss could result.
Another antibiotic used is Flagyl, which alters the bacteria in the colon and intestines, and may help patients with chronic encephalopathy. There are side effects to this option, such as an “antabuse” reaction to alcohol ingredients, and reactions such as confusion and tingling sensation.
Lactulose is a medication that changes acidity in the colon and decreases ammonia levels in the blood. Lactulose causes loose bowel movements or diarrhea, which is one of the ways the toxins are excreted from the body.
An alternative treatment is sodium benzoate powder and sodium phenylacetate tablets or powder. These compounds absorb ammonia in the intestines and facilitate excretion of toxins through bowel movements. They also enable a process that allows increased removal of ammonia from the blood in the liver.
Zinc deficiency may worsen the encephalopathy a patient has with liver failure or cirrhosis, therefore zinc supplements may be recommended by the physician.
Dietary recommendations include eating 80 grams of protein a day, consisting of soy beans, tofu, beans, legumes and fish, but no red meat. A diet high in protein helps to prevent a decrease in muscle mass.
The presence of encephalopathy in the disease process can significantly interfere with the patient’s life style. Although liver disease itself brings about a progressively weakened condition, the patient may still be able to function somewhat independently, such as preparing meals, doing chores around the house and attending social functions. However, the unpredictability of episodes of encephalopathy makes planning difficult to impossible and involvement in any kind of physical activity very risky. While taking lactulose, the patient may need to stick pretty close to the bathroom, severely restricting activities outside the home.
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