Manifestation of precoma:
- History of liver disease.
- Drowsiness, irritability or slurred speech.
- Flapping tremors.
- Behavioural changes.
Manifestation of coma:
- Coma with liver patient.
Treatment: Hepatic and prehepatic coma → the same treatment.
A- Give glucose 5% solution by IV infusion and add the following drugs to the solution.
1- Nootropil ampoule.
2- Oxybral ampoule.
1 & 2 to improve consciousness.
3- Antibiotic: Cefotax 1 gm vial to protect from infection.
4- Zantac ampoule to protect from sress ulcer.
5- 2 Hepa merz ampoules in the solution in case of coma and hepa merz sachets (1/2 sachet in 1/2 glass of water every 8 hours) in case of precoma to wash out amonia.
B- deal with haematemesis if present:
if haematemesis → red (fresh) blood in case of precoma or coma → Sengstaken-Blakemore tube (life saving) + enema.
if haematemesis → brown (not fresh blood) and the patient is conscious → Ryle tube (gastric lavage) + enema every 2, 4 or 8 hours.
C- Enema to wash out amonia:
R/ Enemax.
Precoma → perform enema every 4 or 8 hours.
Coma → perform enema every 2 hours.
D- Flagyl infusion to prevent anaerobic infection.
R/ Flagyl infusion 500 mg.
May be given in the other arm every 12 hours.
E- Drugs for liver support → continued at home.
R/ Lactulose syrup ( tablespoonful /8 hours).
R/ Inderal tablets (1 tablet 3 times a day) to decrease portal hypertension.
R/ Legalon (Silymarin) (1 tablet 3 times a day) to support liver.
R/ Neomycin 500 tablets (1 tablet 2 times a day) to protect from GIT infection.
R/ Adenoplex ampoule intramuscular every 3 days.
- History of liver disease.
- Drowsiness, irritability or slurred speech.
- Flapping tremors.
- Behavioural changes.
Manifestation of coma:
- Coma with liver patient.
Treatment: Hepatic and prehepatic coma → the same treatment.
A- Give glucose 5% solution by IV infusion and add the following drugs to the solution.
1- Nootropil ampoule.
2- Oxybral ampoule.
1 & 2 to improve consciousness.
3- Antibiotic: Cefotax 1 gm vial to protect from infection.
4- Zantac ampoule to protect from sress ulcer.
5- 2 Hepa merz ampoules in the solution in case of coma and hepa merz sachets (1/2 sachet in 1/2 glass of water every 8 hours) in case of precoma to wash out amonia.
B- deal with haematemesis if present:
if haematemesis → red (fresh) blood in case of precoma or coma → Sengstaken-Blakemore tube (life saving) + enema.
if haematemesis → brown (not fresh blood) and the patient is conscious → Ryle tube (gastric lavage) + enema every 2, 4 or 8 hours.
C- Enema to wash out amonia:
R/ Enemax.
Precoma → perform enema every 4 or 8 hours.
Coma → perform enema every 2 hours.
D- Flagyl infusion to prevent anaerobic infection.
R/ Flagyl infusion 500 mg.
May be given in the other arm every 12 hours.
E- Drugs for liver support → continued at home.
R/ Lactulose syrup ( tablespoonful /8 hours).
R/ Inderal tablets (1 tablet 3 times a day) to decrease portal hypertension.
R/ Legalon (Silymarin) (1 tablet 3 times a day) to support liver.
R/ Neomycin 500 tablets (1 tablet 2 times a day) to protect from GIT infection.
R/ Adenoplex ampoule intramuscular every 3 days.
No comments:
Post a Comment