Special Medications

-Sorbitol 500 mL in 200 mL of water PO now.

-Lactulose 30-45 mL PO q1h for 3 doses, then 15-45 mL PO bid-qid, titrate to produce 3 soft stools/d OR

-Lactulose enema 300 mL in 700 mL of tap water; instill 200-250 mL per rectal tube bid-qid. AND

-Metronidazole (Flagyl) 250 mg PO q6h.

-Ranitidine (Zantac) 50 mg IV q8h or 150 mg PO bid OR

-Famotidine (Pepcid) 20 mg IV/PO q12h.

-Flumazenil (Romazicon) 0.2 mg (2 mL) IV over 30 seconds q1min until a total dose of 3 mg; if a partial response occurs, continue 0.5 mg doses until a total of 5 mg. Flumazenil may help reverse hepatic encephalopathy, even in the absence of benzodiazepine use. Excessive doses of flumazenil may precipitate seizures.

-Multivitamin PO qAM or 1 ampule IV qAM.

-Thiamine 100 mg PO/IV qd.

-Vitamin K 10 mg SQ qd for 3 days if elevated INR.

11. Extras: CXR, ECG; GI and dietetics consults.

12. Labs: Ammonia, CBC, platelets, SMA 7&12, AST, ALT, GGT, LDH, alkaline phosphatase, protein, albumin, bilirubin, INR/PTT, ABG, blood C&S x 2, hepatitis B surface antibody. UA.

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