[Therapeutic management of hepatic encephalopathy]

Therapeutic management in hepatic encephalopathy depends on its etiology as well as progression degree. Both in acute and chronic encephalopathy one should tend to establish probable causes and try to eliminate them. Cutting down on proteins in diet is one of the most important suggestions in chronic hepatic encephalopathy. In order to reduce intestinal production of ammonia, non-absorbable disaccharides (lactulose), antibiotics (neomycin) and sodium benzoate are the most commonly used. Branched chain amino acids administered orally or parenterally may be useful in improving patient's condition and restoring the balance of blood amino acids. The GABA-benzodiazepine receptor theory led to application of its antagonists, such as flumazenil, in the management of hepatic encephalopathy. However, providing a proper treatment is not easy due to unstable and often not very characteristic course of hepatic encephalopathy. What is more, clinical trials of some drugs used in the treatment of hepatic encephalopathy do not confirm their effectiveness.