Changes

| '''Portosystemic encephalopathy<br>

| '''Portosystemic encephalopathy<br>

'''Hepatic coma'''

'''Hepatic coma'''

| See also:

| See also:

| '''[[Hepatic Encephalopathy - Horse|Hepatic Encephalopathy in Horses]]'''

| '''[[Hepatic Encephalopathy - Horse|Hepatic Encephalopathy in Horses]]'''

==Treatment==

==Treatment==

The underlying cause of the HE should be treated, including surgical ligation of '''congenital''' PSS.  In the meantime, the HE should be managed medically with a typical regime involving the following components:

The underlying cause of the HE should be treated, including surgical ligation of '''congenital''' PSS.  In the meantime, the HE should be managed medically with a typical regime involving the following components:

*'''Withhold food'''

*'''Food should be withheld'''

*'''Intra-venous fluid therapy''', which can also be used to correct any hypokalaemia or metabolic alkalosis which may be precipitating the HE.  

*'''Intra-venous fluid therapy''', which can also be used to correct any hypokalaemia or metabolic alkalosis which may be precipitating the HE.  

*'''Enemas''' of warm water or lactulose to decrease the population of bacteria in the [[Colon - Anatomy & Physiology|colon]].

*'''Enemas''' of warm water or lactulose to decrease the population of bacteria in the [[Colon - Anatomy & Physiology|colon]].

*'''Antibiotics''' given orally or by per rectum to reduce the number of colonic bacteria.  Suitable products include [[Penicillins|ampicillin]], [[Aminoglycosides|neomycin]] (which, although highly toxic when administered systemically, is also highly polar and therefore restricted to the GI tract) or [[Nitroimidazoles|metronidazole]].

*'''Antibiotics''' given orally or by per rectum to reduce the number of colonic bacteria.  Suitable products include [[Penicillins|ampicillin]], [[Aminoglycosides|neomycin]] (which, although highly toxic when administered systemically, is also highly polar and therefore restricted to the GI tract) or [[Nitroimidazoles|metronidazole]].

*[[Drugs Acting on the Intestines#Osmotic Laxatives|'''Lactulose''']] can be given orally or by enema.  It is a synthetic disaccharide which, when metabolised by the acidifying colonic bacteria, donates a hydrogen ion to ammonia to form ammonium ions.  Because these ions are charged, the are not absorbed freely and are rather trapped in the colon and excreted in faeces.  Lactulose also acts as an osmotic laxative, preventing constipation and reducing the time that colonic bacteria are able to act on undigested amino acids to form ammonia.  

*[[Lactulose|'''Lactulose''']] can be given orally or by enema.  It is a synthetic disaccharide which, when metabolised by the acidifying colonic bacteria, donates a hydrogen ion to ammonia to form ammonium ions.  Because these ions are charged, the are not absorbed freely and are rather trapped in the colon and excreted in faeces.  Lactulose also acts as an osmotic laxative, preventing constipation and reducing the time that colonic bacteria are able to act on undigested amino acids to form ammonia.  

*When the animal is to be fed, a '''diet with a high carbohydrate, low protein (2g/kg/day) and low fat''' content is recommended.  Both soluble and insoluble fibre may be beneficial in appropriate quantities as the former traps ammonia in the colon and the latter reduces intestinal transit time and prevents constipation.  In an animals with PSS or severe hepatic insufficiency, it may not be advisable to restrict protein too assiduously as these animals are likely to be [[Hypoalbuminaemia|hypoalbuminaemic]].

*When the animal is to be fed, a '''diet with a high carbohydrate, low protein (2g/kg/day) and low fat''' content is recommended.  Both soluble and insoluble fibre may be beneficial in appropriate quantities as the former traps ammonia in the colon and the latter reduces intestinal transit time and prevents constipation.  In an animals with PSS or severe hepatic insufficiency, it may not be advisable to restrict protein too assiduously as these animals are likely to be [[Hypoalbuminaemia|hypoalbuminaemic]].

*'''Seizures''' should be treated with anticonvulsant medication but benzodiazepines should be avoided as they may worsen the HE.   

*'''Seizures''' should be treated with anticonvulsant medication but [[Benzodiazepines|benzodiazepines]] should be avoided as they may worsen the HE.   

[[Category:Dog]][[Category:Cat]]

[[Category:Dog]][[Category:Cat]]

[[Category:To_Do_-_James]]

[[Category:To_Do_-_James]]