Question

Carl Vinson, a 65-year-old Caucasian man, was admitted today with increased shortness of breath, fatigue, and decreased level of consciousness. Mr. Vinson has a history of liver disease, most likely related to a long history of alcohol use. Upon arrival to the unit, he is somnolent and responds only to shouting and shaking. Upon arousal, he is only able to state his first name. His wife accompanies him to the unit, and describes that he has become increasingly restless over the last 3 days, and she is concerned for his safety. Additionally, he has not eaten or taken in any fluids in 24 hours. (Learning Objectives 2, 3, and 6)
a. Correlate the patient’s presenting clinical manifestations to hepatic encephalopathy.
b. The physician orders a STAT ammonia level, along with a CBC and complete chemistry panel. The ammonia result is elevated. What is your interpretation?
c. The physician orders Mr. Vinson to receive lactulose (Cephulac) orally. What is the rationale for this medication?
d. Mrs. Vinson asks why her husband must decrease intake of protein. How will you respond to her question?

Answer 1

The symptoms match with hepatic encephalopathy (i.e., fatigue, anxiety, confusion, muscle twitches). Moreover, it is well known that high ammonia levels may be associated with liver diseases (e,g, cirrhosis).

• Hepatic encephalopathy refers to a nervous system disease triggered by severe liver impairment.

• The symptoms of hepatic encephalopathy, include, among others, anxiety, confusion, muscle twitches, signals of fatigue, lethargy, etc.

• The administration of lactulose is correct because this medication prevents complications in liver disease derived from hepatic encephalopathy.

• Ammonia tests are used to determine the ammonia concentration in the blood, where a high ammonia level may be indicative of liver diseases (e,g, cirrhosis).

• A low-protein diet can significantly reduce the production of ammonia and thus prevents complications derived from hepatic encephalopathy.

In conclusion, the symptoms match with hepatic encephalopathy (i.e., fatigue, anxiety, confusion, muscle twitches). Moreover, it is well known that high ammonia levels may be associated with liver diseases (e,g, cirrhosis).

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