Changes

*Enemas to decrease the amount of bacteria in the colon.

*Enemas to decrease the amount of bacteria in the colon.

*Oral antibiotics such as [[Penicillins|ampicillin]], [[Aminoglycosides|neomycin]] or [[Nitroimidazoles|metronidazole]] can be given initially reduce the amount of bacteria in intestines and hence decrease the production of ammonia.

*Oral antibiotics such as [[Penicillins|ampicillin]], [[Aminoglycosides|neomycin]] or [[Nitroimidazoles|metronidazole]] can be given initially reduce the amount of bacteria in intestines and hence decrease the production of ammonia.

*Lactulose PO

*[[Drugs Acting on the Intestines#Osmotic Laxatives|Lactulose]] PO

**This is a synthetic disaccharide which is metabolised by the acidifying colonic bacteria.  Ammonia is converted into ammonium ions, which cannot be absorbed and hence trapped in the colon and excreted in the faeces.  [[Drugs Acting on the Intestines#Osmotic Laxatives|Lactulose]] also acts as an osmotic laxative, allowing more faeces and bacteria to be washed out.

**This is a synthetic disaccharide which is metabolised by the acidifying colonic bacteria.  Ammonia is converted into ammonium ions, which cannot be absorbed and hence trapped in the colon and excreted in the faeces.  [[Drugs Acting on the Intestines#Osmotic Laxatives|Lactulose]] also acts as an osmotic laxative, allowing more faeces and bacteria to be washed out.

*A high carbohydrate, low protein (2g/kg/day) and low fat diet is recommended.

*A high carbohydrate, low protein (2g/kg/day) and low fat diet is recommended.