A 55-year-old man on ICU with fulminant hepatic failure has a serum ammonia of 250 µmol/L. His ICP is 30 mmHg. In addition to osmotherapy and potentia...

Question

A 55-year-old man on ICU with fulminant hepatic failure has a serum ammonia of 250 µmol/L. His ICP is 30 mmHg. In addition to osmotherapy and potentially CRRT for ammonia clearance, what pharmacological approach can reduce intestinal ammonia production?

Accepted Answer

Lactulose (enteral, via NG or rectal) - lactulose is metabolised by colonic bacteria to lactic and acetic acid, which: (1) acidifies the colonic lumen, converting diffusible NH3 to non-diffusible NH4+ (ionic trapping); (2) acts as an osmotic laxative, accelerating ammonia-containing faecal transit; AND oral rifaximin - a non-absorbable antibiotic that reduces ammonia-producing gut bacteria

Answer

Oral ciprofloxacin only

Answer

IV lactulose

Answer

Increasing dietary protein to stimulate hepatic ammonia clearance

Answer

Oral activated charcoal

uk-fficm MCQ (SBA): Ammonia Reduction in ALF

A 55-year-old man on ICU with fulminant hepatic failure has a serum ammonia of 250 µmol/L. His ICP is 30 mmHg. In addition to osmotherapy and potentially CRRT for ammonia clearance, what pharmacological approach can reduce intestinal ammonia production?