Factors precipitating hepatic encephalopathy are all except

Ans. d (Diarrohea). (Ref. Harrison, 18th ed./Chapter 308. Cirrhosis and Its Complications)Precipitants of hepatic encephalopathy# Alkalosis, azotemia# Drugs (diuretics, narcotics, tranquilizers, sedative)# Hypokalemia, hyponatremia, hypoxia, hypovolemia# Infection# Portosystemic shunts# Constipation# Excess dietary protein# Progressive liver failure/ disease# Superimposed acute liver disease# SurgeryHEPATIC ENCEPHALOPATHY - TREATMENT:Sometimes hydration and correction of electrolyte imbalance is all that is necessary. Restriction of dietary protein is nowadays discouraged. There may be some benefit to replacing animal-based protein with vegetable-based protein. The mainstay of treatment for encephalopathy, in addition to correcting precipitating factors, is to use lactulose, a non- absorbable disaccharide, which results in colonic acidification. Catharsis ensues, contributing to the elimination of nitrogenous products in the gut that are responsible for the development of encephalopathy. The goal of lactulose therapy is to promote 2-3 soft stools per day. Poorly absorbed antibiotics are often used as adjunctive therapies for patients who have had a difficult time with lactulose. The alternating administration of neomycin and metronidazole has commonly been employed to reduce the individual side effects of each: neomycin for renal insufficiency and ototoxicity and metronidazole for peripheral neuropathy. More recently, rifaximin at 550 mg twice daily has been very effective in treating encephalopathy without the known side effects of neomycin or metronidazole. Zinc supplementation is sometimes helpful in patients with encephalopathy and is relatively harmless.