Cirrhosis

[needhelpnow254]

With cirrhosis how can I control my ammonia levels, what are my options in medications,

[HectorSF]

Lactulose and rifaximin are the standard treatment meds now. They both work differently and the combination works to prevent future occurrences of hepatic encephalopathy (HE).  

Hepatic encephalopathy is reversible with treatment. This relies on suppressing the production of the toxic substances in the intestine and is most commonly done with the laxative lactulose or with non-absorbable antibiotics such as rifaximin.

It is caused by accumulation in the bloodstream of toxic substances that are normally removed by the liver. The diagnosis of hepatic encephalopathy requires the presence of impaired liver function and the exclusion of an alternative explanation for the symptoms. Blood tests (ammonia levels) may assist in the diagnosis. Attacks are often precipitated by an intercurrent problem, such as infection or constipation.

Signs and symptoms

The mildest form of hepatic encephalopathy is difficult to detect clinically, but may be demonstrated on neuropsychological testing. It is experienced as forgetfulness, mild confusion and irritability. More severe encephalopathy is characterised by an inverted sleep-wake pattern (sleeping by day, being awake at night), marked irritability, tremor, difficulties with coordination and trouble writing.

More severe forms of hepatic encephalopathy lead to a worsening level of consciousness, from lethargy to somnolence and eventually coma. In the intermediate stages, a characteristic jerking movement of the limbs is observed (asterixis, "liver flap" due to its flapping character); this disappears as the somnolence worsens. There is disorientation and amnesia, and uninhibited behaviour may occur. Coma and seizures represent the most advanced stage; cerebral oedema (swelling of the brain tissue) leads to death.

Encephalopathy often occurs together with other symptoms and signs of liver failure. These may include jaundice (yellow discolouration of the skin and the whites of the eyes), ascites (fluid accumulation in the abdominal cavity), and peripheral edema (swelling of the legs due to fluid build-up in the skin).

- Everything you wanted to know about protein and cirrhotics, but were afraid to ask -

Protein intake must be adjusted in accordance with a person’s body weight and the degree of liver damage present. Approximately 0.8 grams of protein per kilogram (2.2 pounds) of body weight is recommended in the diet each day for someone with compensated cirrhosis. As such, total protein intake would range between about 40 and 100 grams per day—equaling the approximate 20 to 30 percent of daily calories derived from protein that a person should ideally consume.

Protein & hepatic encephalopathy(HE) in decompensated cirrhosis -

A diet high in animal protein (which contains a lot of ammonia) may precipitate an episode of encephalopathy among these people. Researchers aren’t exactly sure what causes encephalopathy, but they suspect that an excess of ammonia in the body may be one of the triggers.

Vegetarian diets, on the other hand, have a low ammonia content and have been shown to be much less likely than animal protein diets to induce encephalopathy. Also, vegetable fiber plays a role in helping to eliminate harmful waste substances, such as ammonia, from the body. Therefore, people prone to encephalopathy are advised to maintain a high intake of vegetable protein and a low intake of animal protein, or even better, to become vegetarians. This type of diet will help control mental symptoms in people suffering from some degree of chronic encephalopathy—that is, those who have some degree of mental confusion and/or memory loss all the time.

Why certain types of protein are better than other for cirrhotics -

When choosing animal protein, it is important to choose lean (low-fat) cuts of meat- such as fish, white meat chicken and white meat turkey. Keep in mind that even the leanest cuts of red meat are high in fat content. In fact, approximately 50 to 75 percent of calories from most red meats actually come from fat! Even a carefully trimmed cut of fine lean red meat probably derives about 50 percent of its calories from fat.

No more Mickey D's Big Macs!!! Darn.

I take both lactulose and rifaximin and they really are helpful. Make sure you take enough lactulose to have about 3 bowel movements a day for the med to be effective. We usually don't realize how "out of it we are". It is usually others that point it out. We are like the drunk driver who thinks they are driving fine while in reality they are swerving back and forth.

Good luck!
Hectorsf

[eureka254]

My husband also has cirrhosis but I don't know much about the meds -- he has not been prescribed anything for ammonia because his levels seem to be under control.  From a control stand point, as Bill1954 points out, it's important to stay away from red meat -- vegetable proteins and fish are the best sources of protein to help control ammonia.  My husband has replaced much of his red-meat consumption with peanut butter, sardines, beans, and such.  He personally abhors tofu, so for him, it's lots of nuts (almonds, cashews, etc.) and occasional cheese or eggs or ice cream as a treat.  When he suffers from poor appetite his hep doc encourages protein drinks to ensure adequate protein intake.  Hope that helps.
~eureka

[Bill1954]

They will likely prescribe Lactulose and perhaps rifaximin as well. On your end, eat red meat sparingly, if at all; the ammonia is a byproduct of poor protein metabolism, I believe. Try to get plenty of protein through white meat chicken, legumes, bean curd (tofu), etc.

I imagine the doctor will also limit sodium intake as well, although for other reasons.

Best of luck, and welcome to the discussion group—

Bill