How to Treat Hepatic Encephalopathy

Lactulose is still, in my opinion, the absolute frontline therapy for this. You want to give them a lot of lactulose fairly frequently until they are having regular bowel movements. A study that looked at using peg or a leader of polyethylene glycol upfront to get them pooping actually got better from the encephalopathy standpoint than people who were given lactulose as a standard way. The nice thing is that lactulose works very nicely as an enema and has the same effect as taking it orally.