Coma, hepatic

Kanamycin, neomycin, and paromomycin are used orally in the management of hepatic coma. In this disorder, liver failure results in an elevation of blood ammonia levels. By reducing tire number of ammoniaforming bacteria in the intestines, blood ammonia levels may be lowered, thereby temporarily reducing some of the symptoms associated with this disorder. 

When kanamycin or neomycin is given for hepatic coma, the nurse must evaluate the patient s level of consciousness and ability to swallow. 

Loop diuretics are contraindicated in patients with known hypersensitivity to the loop diuretics or to the sulfonamides, severe electrolyte imbalances, hepatic coma, or anuria, and in infants (ethacrynic acid). 

The energy substrates are contraindicated in patients with hypersensitivity to any component of the solution. Dextrose solutions are contraindicated in patients with diabetic coma with excessively high blood sugar. Concentrated dextrose solutions are contraindicated in patients with increased intracranial pressure, delirium tremens (if patient is dehydrated), hepatic coma, or glucose-galactose malabsorption syndrome Alcohol dextrose solutions are contraindicated in patients with epilepsy, urinary tract infections, alcoholism, and diabetic coma... 

In patients with hepatic coma, decreases in the production and absorption of ammonia from the gastrointestinal (GI) tract will be beneficial. The antibiotic of choice in this situation would be... 

FIGURE 34-2 Typical pattern of Alzheimer type II astrocytosis in frontal cortex of a 51-year-old cirrhotic patient who died in hepatic coma. Note astrocytes with large pale nucleus and margination of chromatin (large arrow). Doublets of Alzheimer type II cells frequently appear (open arrowhead). 

Symptoms for the first four deficiencies include anorexia, vomiting and lethargy, from which patients may progress to irreversible coma (acute hepatic coma) and death. If infants survive, but remain undiagnosed and untreated for some time, they become mentally handicapped. In arginase... 

Osmotic laxative effects are also produced by the polyhydric alcohols, mannitol and sorbitol, which unlike glucose cannot be transported through the intestinal mucosa, as well as by the non-hydrolyzable disaccharide, lactubse. Fermentation of lactulose by colon bacteria results in acidification of bowel contents and microfloral damage. Lactulose is used in hepatic failure in order to prevent bacterial production of ammonia and its subsequent absorption (absorbable NH3 nonabsorbable NH4+), so as to forestall hepatic coma. 

Zieve L, Doizaki WM, Zieve FJ Synergism between mercaptans and ammonia or fatty acids in the production of coma A possible role for mercaptans in the pathogenesis of hepatic coma. J Lab Clin Med 83 16-28, 1974... 

Anuria renal decompensation hypersensitivity to thiazides or related diuretics or sulfonamide-derived drugs hepatic coma or precoma (metolazone). 

Anuria hypersensitivity to these compounds or to sulfonylureas infants (ethacrynic acid) patients with hepatic coma or in states of severe electrolyte depletion until the condition is improved or corrected (bumetanide). 

Hepatic function impairment Use of methazolamide in this condition could precipitate hepatic coma. 

Liver and kidney disease Use with extreme caution in patients with advanced hepatorenal disease and in all patients with abnormal liver function tests because hepatic coma may be precipitated. 

Nausea, vomiting, diarrhea (most common) malabsorption syndrome characterized by increased fecal fat, decreased serum carotene, and fall in xylose absorption. Clostridium difficile-assoaated colitis (following neomycin therapy) nephrotoxicity and ototoxicity (following prolonged and high-dosage therapy in hepatic coma). 

WARNING Systemic absorption of oral route may cause neuro/oto/nephrotox may result resp paralysis possible w/ any route of administration Uses Hepatic coma, bowel prq) Action Aminoglycoside, poorly absorbed PO -1- GI bacterial flora Dose Adults. 3-12 g/24- h PO in 3-4 doses Peds. 50-1 (X) mg/kg/24 h PO in 3-4 doses Caution [C, /-] Renal failure, neuromuscular disorders, hearing impair Contra Intestinal obst Disp Tabs, PO soln SE Hearing loss w/ long-term use rash, NA EMS Use neuromuscular blockers w/ caution, reduced dose may be necessary t bleeding risk w/ concurrent anticoagulant use OD May cause neuromuscular block and kidney failure calcium salts can be used to revise neuromuscular block... 

A 50-year-old man diagnosed with hepatic coma was successfully treated with a daily oral dose of neomycin 2 weeks prior to coming to your clinic. The patient complains that he can t hear as well now as he could prior to his recent hospitalization. You suspect that this may be due to the patient s treatment during his episode with hepatic coma. What is your next response ... 

Contraindications Anuria, hepatic coma, severe electrolyte depletion... 

Contraindications Anuria, hepatic coma or precoma, history of hypersensitivity to sulfonamides or thiazide diuretics, renal decompensation... 

In the presence of severe renal and hepatic disease, these drugs may precipitate renal failure or hepatic coma. The most important toxic effect associated with thiazide therapy is hypokalemia and hypochloremic alkalosis. 

It is a semisynthetic disaccharide of fructose and lactose. It is not digested or absorbed in small intestine thereby withdrawing water into bowel lumen. It breaks down in colon to form more osmotically active products. It also causes reduction in ammonia in hepatic coma. 

In preparation for elective bowel surgery, 1 g of neomycin is given orally every 6-8 hours for 1-2 days, often combined with 1 g of erythromycin base. This reduces the aerobic bowel flora with little effect on anaerobes. In hepatic coma, coliform flora can be suppressed by giving 1 g every 6-8 hours together with reduced protein intake, thus reducing ammonia intoxication. Use of neomycin for hepatic coma has been almost entirely supplanted by lactulose, which is much... 

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