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Lactulose is the standard of care for treating patients with hepatic encephalopathy (HE); it has several postulated mechanisms of action, including trapping ammonium ions and cleansing ammoniagenic organisms from the gut. In this study, researchers at Parkland Hospital in Dallas assessed the efficacy of simple catharsis using polyethylene glycol (PEG) 3350-electrolyte solution, often used for colonoscopy preparation. Fifty patients (mean age, 56; mostly Hispanic men) with cirrhosis and altered mental status attributed to HE were randomized to a standard lactulose protocol or a PEG protocol (4 L administered orally or through a nasogastric tube during 4 hours).
Patients were assessed at 24 hours after therapy; at that time, patients randomize…