IBCC Episode 38 - Hepatic Encephalopathy

In this episode of The Internet Book of Critical Care Podcast, Josh and Adam discuss the complexities of severe hepatic encephalopathy in ICU patients with chronic hepatic dysfunction, distinguishing it from acute hepatic failure. They explore the challenges in diagnosing hepatic encephalopathy due to the lack of definitive lab tests and its overlap with other conditions like hyponatremia and alcohol withdrawal. The discussion covers clinical features, lab studies, and the importance of excluding other potential causes of delirium. They emphasize a treatment approach centered on managing triggers like infections and GI bleeds, employing double-pronged gut therapy with lactulose and rifaximin to reduce nitrogen load, and avoiding sedatives that can hinder patient recovery. The hosts also touch on managing metabolic derangements such as hyponatremia, hypernatremia, and hypokalemia, as well as nutritional support and gut access strategies, including preemptive placement of small-bore feeding tubes before extubation.