In hepatic encephalopathy, what is the cornerstone of management?

• A. Increase protein intake
• B. Administer lactulose, restrict protein intake, and monitor mental status
• C. Administer diuretics
• D. Liver transplant

Answer: (B)

The main idea is reducing ammonia buildup to control hepatic encephalopathy. The best approach is to lower ammonia production and absorption and to monitor the patient’s mental status. Lactulose is used because it acidifies the colon and converts ammonia to ammonium, which is not easily absorbed, and it also promotes bowel movements to hasten ammonia elimination. Limiting dietary protein decreases the substrate available for gut bacteria to produce ammonia. Regularly assessing mental status helps guide therapy and detect any deterioration or improvement. Diuretics aren’t a primary treatment for hepatic encephalopathy (they’re used for ascites in liver disease), and liver transplant, while a definitive option for end-stage disease, isn’t the immediate cornerstone of HE management. Increasing protein intake would worsen ammonia production and the condition.