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Brain dysfunction directly due to liver dysfunction - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Liver and Gall Bladder
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2584 Questions
User :   null
Doctor :   Hi
User :   My father , 63 yrs has faced esophageal varices since a year, and is a diabetic patient. further treatment USG showed having early liver cirhosis. now a days he is facing hepatic encephalopathy and remains dull and confused whole day. Local doctors have given him to take lactulose but it is not working. in a week he remains fine for one or two day but remains confused. Please advice me.
User :   Hi
Doctor :   Let me read the query
Doctor :   Ok
Doctor :   Let me breif you
User :   what should be my next step
Doctor :   Its a brain dysfunction directly due to liver dysfunction, most often recognized in advanced liver diseas
Doctor :   Lactulose is the correct supplement he requires
Doctor :   The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors.
Doctor :   Is he on complete abstinence from alcohol now
Doctor :   What other drugs is getting right along with lactulose
User :   previously he used to take alcohol occassionaly. local doctors have also querried this question but the answer was nill. they suspected of Hepatitis but the test result was negative.
Doctor :   Ok
Doctor :   Does he consume more of fatty foods
User :   now a days he is taking Tazloc40mg, Lornit 150mg, Pronol 10mg, Rabifest 20 mg, aldactone 100mg at night and tryptoma 25 mg.
Doctor :   ok
Doctor :   There are four grades in hepatic encephalopathy
User :   No we use to give him boiled foods with less oil
Doctor :   1,Grade 0 - Minimal hepatic encephalopathy is previously known as subclinical hepatic encephalopathy.
Doctor :   2, Grade 1 - Trivial lack of awareness. Shortened attention span. Impaired addition or subtraction. Euphoria
Doctor :   3, Grade 2 - Lethargy or apathy. Disorientation. Inappropriate behavior. Slurred speech
Doctor :   4, Grade 3 - Somnolent but can be aroused, unable to perform mental tasks,
Doctor :   5, Grade 4 - Coma with or without response to painful stimuli
Doctor :   ok
Doctor :   Now your father falls under the category grade 2
User :   about 20 yrs back he recovered from para typhoid, is it might be the cause of cirrhosis
Doctor :   Yes, could be
Doctor :   Was all his viral markers for liver
Doctor :   done
Doctor :   Hepatitis A, B, C , D
User :   yes
Doctor :   OK
Doctor :   As already considerable damage is done the liver
Doctor :   We should now concentrate more on helping him maintain the present status
Doctor :   That by providing supplements he is lack of
Doctor :   proper food, with restrictions in mind
Doctor :   regular medications
User :   what other supplement can we give him
Doctor :   There sachets available with liver protective enzymes
Doctor :   Hepamerz is the brand, but you will need a prescription for it
Doctor :   this drug helps in protecting the liver from further damage to some extent
User :   as he is a diabetic patient, can he take the medicine
User :   he also needs regular Insulin NovaMix 30
Doctor :   Yes
Doctor :   thats a supplement for betterment of liver
Doctor :   Is he getting any sedatives (benzodiazepenes)
User :   no
Doctor :   Thats good
Doctor :   Because its strictly not advisable to give them
Doctor :   Is he having collection of fliud in abdomen
Doctor :   (ASCITIS)
Doctor :   Is his sleep proper
User :   no, but the day he looks fine and responds well he sleeps too much
Doctor :   Ok thats good
Doctor :   But always do keep an eye on him
Doctor :   Because persons with liver disease have sudden onset of severe illnes
Doctor :   when you find him drowsy partially respponding have him examined by a doctor
User :   yes i do
Doctor :   Ok
User :   will he remain like this only in future
User :   or is there any chance of recovery.
Doctor :   AS told the considerable damege is done lets hope for the best
Doctor :   yes there are chances for recovery
User :   shall i take him for further treatment in superspeciality such as Apollo
Doctor :   Yo will have to when required
Doctor :   But as if now he is fine, so he will not require hospitilastion
User :   today also he is not sleeping and is remaining dull.
Doctor :   When you find him more drowsy, irresponsive, excessive irritabilty, rapid respiration
Doctor :   All the above will; require immidiete medical attention
Doctor :   As said they will have mood variations, some times they also turn violent
User :   Ok thanks, lastly can u give me the perfect dose of the medicine Hepamerz.
Doctor :   Mood variations are acceptable, note down for the symptoms listed
Doctor :   As said it needs prescription, being online consultation we have got limitations
Doctor :   Its generally available in sachets no dosage as such, but still ask you to get an prescription for it
Doctor :   Did u follow me
User :   Ok fine
Doctor :   Is there anything else i can help you with
User :   Thanks for the discussion. Hope this will help me in his further treatment.
Doctor :   wishing your father a speedy recovery
User :   Goodnight
Doctor :   Thanks for consulting me.
Doctor :   Bye for now
Doctor :   Good night
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