Table 5.

Pharmacological options for managing overt hepatic encephalopathy

Non-absorbable disaccharides	Lactulose (20-30 g) should be administered orally 3-4 times per day (an equivalent daily dose of lactitol is 67-100 g).
	Goals: it should be administered orally until the patient is having at least 2 bowel movements a day. Thereafter, the dose should be titrated to achieve two to three soft stools per day. If patients cannot take medications orally, administration via nasogastric tube might be tried.
	Enema with lactulose 200 g and 700 mL water might be performed 3-4 times per day in severe cases.
Rifaximin	400 mg three times/day or 550 mg twice/day
Oral BCAA	0.25 g/kg/day
Intravenous LOLA	30 g/day
Albumin	1.5 g/kg/day until clinical improvement or for 10 days, maximum
Polyethylene glycol	A substitute for non-absorbable disaccharides
	4 liters orally

BCAA, branched-chain amino acid; LOLA, L-ornithine-L-aspartate.