2016, Number 3
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Med Int Mex 2016; 32 (3)
Individual comparison of three antiamonio therapies for treatment of hepatic encephalopathy
Dávila-Sosa D, Avilés-Rosas G, Lozano-Nuevo JJ, Vargas-Ayala G, Rodríguez-López L
Language: Spanish
References: 14
Page: 284-295
PDF size: 844.70 Kb.
ABSTRACT
Background: Hepatic encephalopathy is a clinical picture comprising
a variety of neuropsychological disorders in cognitive and emotional
areas, personality, motor activity, memory and consciousness, being
able to progress to coma. Treatment with lactulose and metronidazole
has improved the prognosis; however, there are patients with poor
response to this therapy.
Objetive: To compare the effectiveness of different antiamonio therapies
coupled to the therapeutic measures of the precipitating cause,
such as treatment of hepatic encephalopathy.
Material and Method: An experimental, comparative, longitudinal,
prospective, controlled and blinded clinical trial. A total of
88 patients were randomized into three groups: group A lactulose
(n=30) group B metronidazole (n=29) and group C LOLA (n=29);
degree of hepatic encephalopathy was determined and venous blood
simple was taken to measure ammonia levels, treatment was initiated
based on lactulose or metronidazole or Hepa-Merz
®. Ammonium was
determined again and degree of encephalopathy was determined at
hospital discharge.
Results: The average age of the patients was 51.3±10.3, 51.8±15.2
and 48.3±13.4 years, respectively; p=0.264 when comparing the
groups according to the degree of hepatic encephalopathy at admission
and discharge was obtained. In addition, p=0.207 when comparing
the length of hospital stay was obtained. Finally quantity ammonium
was compared before and after treatment obtaining a p=0.028 in the
lactulose group and p=0.009 in the Hepa-Merz
® group, without finding
significance for the metronidazole group (p=0.294).
Conclusions: Treatment with lactulose and Hepa-Merz
® significantly
reduces ammonia concentration in patients with hepatic encephalopathy,
with no differences in terms of relief of hepatic encephalopathy
or days of hospital stay.
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