Elevated blood ammonia is the most important mechanism for hepatic encephalopathy in patients with cirrhosis, portal venous shunt surgery, and primary liver cancer, and is associated with many triggers, such as upper gastrointestinal bleeding, high-protein diet, large potassium excretion diuresis, ascites, use of sleeping, sedation, anesthesia, constipation, uremia, infection or surgical trauma.
These factors may not only increase the production of neurotoxic substances in the patient's body, increase the toxic effect of neurotoxic substances, and enhance the sensitivity of the patient's brain tissue to various toxic substances, but also increase the permeability of the patient's blood-cerebrospinal fluid barrier and induce encephalopathy. Therefore, in daily life, for those who have significant damage to liver function, high blood ammonia or have precursors of hepatic encephalopathy, to avoid the above triggers, the following two necessary prevention and treatment should be carried out.
1. Strict restriction or fasting of protein is an important source of reducing exogenous ammonia.
However, for most patients, they are in a state of high catabolism, and the intake of excessive restriction or fasting protein can easily aggravate the consumption of muscle tissue in patients, which is not conducive to maintaining the patient's positive nitrogen balance. Therefore, for such patients, it is necessary to avoid excessive intake of protein-induced hepatic encephalopathy and maintain the necessary positive nitrogen balance.
For such patients, the daily calorie intake should be calculated according to the patient's weight, at least 5.02 - 6.69 calories / kg, and the proportion of carbohydrate, fat and protein intake should be allocated according to the patient's condition and blood ammonia, of which plant protein should be preferred for protein intake, followed by dairy protein, and try to avoid eating meat protein. At the same time, attention should also be paid to instructing patients to eat a small number of meals and consume more fresh fruits and vegetables to ensure that the patient's nutritional intake is balanced. Eating more vegetables and fruits also has the advantage of keeping the patient's stool unobstructed and reducing the absorption of intestinal poisons and ammonia.
2. Medication
In addition to controlling the diet, for most patients with hepatic encephalopathy with high blood ammonia, drug treatment should also be used early, such as oral lactulose can not only acidify, smooth the intestines, maintain intestinal purification, but also reduce the absorption of intestinal ammonia; In recent years, studies have found that intestinal microbiome disorders also increase the important way of blood ammonia, oral antibiotics such as rifaximin or probiotics can effectively kill and regulate the number of harmful bacteria in the intestine, L-utilide L-aspartic acid is currently the most important drug to reduce endogenous blood ammonia production, and its mechanism is related to promoting the metabolism of amino acids in the body into urea, which has a significant excretion effect of promoting endogenous ammonia.
Patients with chronic liver disease should regularly go to the hospital to review liver function, etc., evaluate the condition, and once they are found to have the above symptoms, they should be hospitalized immediately.