Hepatic Encephalopathy
Impression: Hepatic encephalopathy
Condition: Fair – Poor
Diet: NPO till stale, Low salt and protein
Activity: As tolerated
Please:
1. CBC, BUN, Cr, Na, UA
2. BS ( Correct hypoglycemia )
3. K ( Correct hypokalemia )
4. PT, PTT, INR
5. LFT
6. VBG ( assess Metabolic alkalosis)
7. CXR ( for aspiration pneumonia )
8. ECG
9. Pulse oximetry ( if needed )
10. O2 nasally 3 lit/min
11. Stool OB ( for blood loss/ variceal bleeding )
12. Abdominal Tap ( if large amount ascites ):
• Cell count – PMN > 250 – R/O SBP
• Culture
13. Lactulose 30 ml PO / via NG Q1hr ( till loose stool, then Tid )
14. Metronidazole 250 mg PO Q8h
