What is the best treatment for acute exacerbation of hepatic encephalopathy?

The best treatment for an acute exacerbation of hepatic encephalopathy is lactulose. This medication acts as a non-absorbable disaccharide that helps to reduce ammonia levels in the blood, which is a key factor in the pathophysiology of hepatic encephalopathy. Lactulose works by promoting the conversion of ammonia to ammonium in the intestinal lumen, effectively trapping it and facilitating its elimination through the feces. Additionally, lactulose helps to reduce the gut pH, which decreases the absorption of ammonia produced by bacteria in the intestines.

While cleansing enemas, intravenous fluids, and diet modification can be part of supportive care in managing patients with liver disease or hepatic encephalopathy, they do not directly target the underlying biochemical derangement associated with the condition. Cleansing enemas might help in some specific cases, especially if there is significant constipation, but they are not a primary treatment for hepatic encephalopathy itself. Intravenous fluids are important to manage hydration and electrolyte imbalances but do not address the elevated ammonia levels. Diet modification may provide overall health benefits but is also not an immediate measure in the acute setting for treating hepatic encephalopathy. Therefore, lactulose remains the cornerstone of treatment in cases of acute exacerbation