What medicine is used for hepatic coma?
Hepatic coma, also known as hepatic encephalopathy, is one of the common complications in patients with severe liver disease. It mainly manifests as disturbance of consciousness, abnormal behavior and even coma. In recent years, therapeutic drugs and programs for hepatic coma have attracted much attention. This article will combine the hot topics and hot content on the Internet in the past 10 days to give you a detailed introduction to medication selection and precautions for hepatic coma.
1. Pathogenesis of hepatic coma
The pathogenesis of hepatic coma is complex and is mainly related to factors such as ammonia poisoning, pseudoneurotransmitters, and amino acid metabolism imbalance. Therefore, drugs for the treatment of hepatic coma mainly focus on reducing blood ammonia, regulating amino acid balance, and improving brain function.
2. Commonly used drugs for hepatic coma
| drug class | Representative medicine | Mechanism of action | Usage and dosage |
|---|---|---|---|
| ammonia-lowering drugs | Lactulose, lactitol | Acidifies the intestines, reducing ammonia absorption | Lactulose: 30-60ml/day, taken orally in divided doses |
| antibiotics | Rifaximin, neomycin | Inhibit ammonia production by intestinal bacteria | Rifaximin: 400mg/time, 3 times/day |
| branched chain amino acids | Compound Amino Acid Injection (3AA) | Correct amino acid imbalance | 250-500ml/day, intravenous drip |
| sedative antagonist | Flumazenil | Antagonizes GABA receptors | 0.5-1mg/time, intravenous injection |
3. Drug treatment plan for hepatic coma
1.Basic treatment:Including limiting protein intake, correcting electrolyte imbalance, maintaining internal environment stability, etc.
2.Ammonia-lowering treatment:Lactulose is the drug of choice and reduces ammonia absorption by acidifying the intestinal environment. For patients who cannot tolerate lactulose, lactitol may be used.
3.Antibiotic treatment:Rifaximin is currently the most commonly used intestinal antibiotic. Its advantage is that it has few adverse reactions and is less likely to develop drug resistance.
4.Branched chain amino acids:It is suitable for patients with stage III-IV hepatic coma and can improve amino acid metabolism imbalance.
5.Other treatments:For patients with severe agitation, flumazenil may be considered, but it should be noted that its duration of action is short.
4. New progress in the treatment of hepatic coma
1.Microecological preparations:In recent years, studies have found that probiotics, prebiotics and other microecological preparations can reduce the production of ammonia by regulating the balance of intestinal flora.
2.Artificial liver support system:For patients whose drug treatment is ineffective, artificial liver support treatments such as molecular adsorption recirculating systems (MARS) can be considered.
3.Liver transplant:For patients with end-stage liver disease, liver transplantation is a curative treatment.
5. Precautions when using medication for hepatic coma
| Things to note | Detailed description |
|---|---|
| drug selection | Choose appropriate drugs according to the stage of hepatic coma. Mild to moderate cases can be administered orally, while severe cases require intravenous administration. |
| Dosage adjustment | Patients with hepatic and renal insufficiency need to adjust dosage to avoid drug accumulation |
| Adverse reaction monitoring | Pay attention to adverse reactions such as diarrhea and electrolyte imbalance |
| Combination medication | Avoid combined use with sedatives and other drugs that may aggravate hepatic coma |
6. Prevention of hepatic coma
1. Patients with cirrhosis should regularly monitor blood ammonia levels
2. Avoid high-protein diets, especially animal proteins
3. Promptly treat triggering factors such as gastrointestinal bleeding
4. Follow the doctor’s instructions and use medications in a standardized manner, and do not use sedatives at will.
7. Summary
The treatment of hepatic coma requires the comprehensive use of a variety of drugs, with the main goals of reducing blood ammonia and improving brain function. With the development of medicine, new treatments are constantly emerging, but early prevention and standardized treatment are still the key. Patients should use medications rationally under the guidance of a doctor and pay attention to lifestyle adjustments to reduce the risk of hepatic coma.
It needs to be emphasized that the treatment of hepatic coma is individualized, and the specific medication plan must be formulated by a professional doctor based on the patient's condition. This article is for informational purposes only and is not a substitute for professional medical advice.
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