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The Benefits of Lactulose Enemas for Hepatic Encephalopathy
Lactulose would be started in the emergency department. You can start refaximin, but that's used primarily for long term maintenance. The PEG is primarily given by a NG tube. If they're not able to swallow, they may be at a point where they need intubation if there are no other reason to protect their airway. And you've got the option now of using PEG and someone who's quite seriously ill with encephalopathy, but has to be given through an NG tube.