Dávila-Sosa D, Avilés-Rosas G, Lozano-Nuevo JJ, Vargas-Ayala G, Rodríguez-López L

Language: Spanish
References: 14
Page: 284-295
PDF size: 844.70 Kb.

ABSTRACT

Background: Hepatic encephalopathy is a clinical picture comprising a variety of neuropsychological disorders in cognitive and emotional areas, personality, motor activity, memory and consciousness, being able to progress to coma. Treatment with lactulose and metronidazole has improved the prognosis; however, there are patients with poor response to this therapy.
Objetive: To compare the effectiveness of different antiamonio therapies coupled to the therapeutic measures of the precipitating cause, such as treatment of hepatic encephalopathy.
Material and Method: An experimental, comparative, longitudinal, prospective, controlled and blinded clinical trial. A total of 88 patients were randomized into three groups: group A lactulose (n=30) group B metronidazole (n=29) and group C LOLA (n=29); degree of hepatic encephalopathy was determined and venous blood simple was taken to measure ammonia levels, treatment was initiated based on lactulose or metronidazole or Hepa-Merz^®. Ammonium was determined again and degree of encephalopathy was determined at hospital discharge.
Results: The average age of the patients was 51.3±10.3, 51.8±15.2 and 48.3±13.4 years, respectively; p=0.264 when comparing the groups according to the degree of hepatic encephalopathy at admission and discharge was obtained. In addition, p=0.207 when comparing the length of hospital stay was obtained. Finally quantity ammonium was compared before and after treatment obtaining a p=0.028 in the lactulose group and p=0.009 in the Hepa-Merz^® group, without finding significance for the metronidazole group (p=0.294).
Conclusions: Treatment with lactulose and Hepa-Merz^® significantly reduces ammonia concentration in patients with hepatic encephalopathy, with no differences in terms of relief of hepatic encephalopathy or days of hospital stay.

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