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Newer Treatment Strategies for Treatment of Hepatic Encephalopathy in ACLF

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Dr RK Dhiman    05 December 2018

  • HE with all grades of severity and independent of other organ failures is associated with increased mortality; the mortality is higher in grade 3-4 compared with grade 1-2 HE.
  • Inflammation plays a greater role in the pathogenesis of HE in patients with ACLF than in patients without ACLF and is associated with cytokine storm.
  • Ammonia is a simple surrogate marker for HE in ACLF and correlates with severity of HE/cerebral failure.
  • Ammonia levels at baseline > 144 mmol/l predicts mortality.
  • Management of HE in hospitalized patients requires admission to the ICU and includes identification and treatment of precipitating factors, including infections; and specific measures for decreasing hyperammonemia and systemic inflammation.
  • Large volume plasmapheresis or albumin dialysis and identification and embolization of portosystemic shunts may be required in refractory patients.

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