A 55-year-old man with cirrhosis presents with grade 2 hepatic encephalopathy (confusion, asterixis, disorientation). Which is the first-line pharmacologic treatment?
- A Oral lactulose ✓
- B Oral neomycin
- C Oral rifaximin
- D IV L-ornithine L-aspartate
Correct answer: A. Oral lactulose
Explanation
Lactulose is the first-line therapy for hepatic encephalopathy. It works by acidifying the colon, reducing ammonia absorption, and promoting ammonia excretion in stool. Rifaximin is added as adjunctive therapy for secondary prevention but is not first-line monotherapy. Neomycin is no longer recommended due to nephrotoxicity and ototoxicity.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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