Regarding hepatic encephalopathy which of the following is TRUE / FALSE? 1. The correlation between severity of liver disease and height of ammonia levels is often poor 2. Lactulose, results in colonic alkalification 3. The mainstay of treatment for encephalopathy is lactulose, an absorbable disaccharide. 4. Rifaximin at 550 mg twice daily is not very effective in treating encephalopathy 5. It is a poor prognostic sign

Ammonia levels are typically elevated in patients with hepatic encephalopathy, but the correlation between severity of liver disease and height of ammonia levels is often poor. The mainstay of treatment for encephalopathy to use lactulose, a nonabsorbable disaccharide, which results in colonic acidification. Rifaximin at 550 mg twice daily has been very effective in treating encephalopathy without the known side effects of neomycin or metronidazole. The development of encephalopathy in patients with chronic liver disease is a poor prognostic sign. Ref: Harrisons Principles of Internal Medicine, 18th Edition, Page 2601