Question

"A 45-year-old man with a history of alcoholic cirrhosis presents to the Emergency Department for confusion. His family brought him. They deny recent trauma, infection, bloody emesis, or stool. He is unable to give a coherent history but seems pleasantly confused. Family reports that he no longer drinks alcohol and has not used any medications or drugs recently. On exam, he is drowsy and delirious. His hands flap when held up, and his tongue gyrates back and forth when protruded. Guaiac testing is negative. His abdomen is distended but soft and nontender. A noncontrast computed tomography scan of the head shows no evidence of bleeding. His renal function is normal, sodium levels are within normal ranges, liver function tests are within his normal ranges, and blood counts are normal. His ammonia level is elevated at 114 µmol/L. What therapy should be initiated?

a) Albumin
b) Cefotaxime
c) Lactulose
d) Paracentesis"

Answer 1

Treatment with lactulose is the appropriate therapy for a patient with hepatic encephalopathy, which is indicated by confusion, asterixis, and elevated ammonia levels in the context of alcoholic cirrhosis.

Step-by-step explanation:

The therapy that should be initiated for a 45-year-old man with a history of alcoholic cirrhosis presenting with confusion, asterixis (flapping of the hands), and elevated ammonia levels, is treatment for hepatic encephalopathy. Considering the absence of recent trauma, infection symptoms, or renal dysfunction, the elevated ammonia level seems to be causing his neurologic symptoms.

Lactulose is the mainstay treatment for lowering ammonia levels. It works by acidifying the contents of the gut, which traps ammonia in the gut and prevents its absorption, followed by its elimination in stool. Cefotaxime or paracentesis do not directly address elevated ammonia levels and therefore, would not be the first-line treatment in this scenario.