A 52-year-old man with cirrhosis secondary to hepatitis C presents with acute abdominal distention, confusion, and asterixis. Vital signs show BP 118/76, HR 92, RR 18, Temp 37.2°C. He consumed a large protein-rich steak meal yesterday. Serum ammonia is markedly elevated at 180 μmol/L (normal <50). Laboratory studies reveal preserved synthetic function with INR 1.2. He denies fever or abdominal pain. Which intervention is most appropriate initially?
- A)Spironolactone initiation
- B)Immediate portosystemic shunt placement
- C)Fresh frozen plasma transfusion
- D)Albumin infusion
- E)Lactulose and rifaxomicinGABARITO
Explicação
Lactulose reduces colonic ammonia absorption, while rifaxomicin (a nonabsorbable antibiotic) reduces ammonia-producing bacteria. This combination is first-line for hepatic encephalopathy management. Ver explicação completa e trilha adaptativa →