Treatments for Alpers Syndrome
Treatments for Alpers Syndrome
The list of treatments mentioned in various sources
for Alpers Syndrome
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
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Discussion of treatments for Alpers Syndrome:
There is no cure for Alpers' disease and, currently, no
way to slow its progression. Treatment is symptomatic and supportive.
Anticonvulsants may be used to treat the seizures. However, caution should
be used when selecting valproate as therapy since it may increase the risk
of liver failure. Physical therapy may help to relieve spasticity and
maintain or increase muscle tone.
(Source: excerpt from
NINDS Alpers' Disease Information Page: NINDS)
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Viral hepatitis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
No specific drug therapy has been developed for hepatitis, with the exception of hepatitis C, which has been treated somewhat successfully with interferon alpha. Instead, patients are advised to rest in the early stages of the illness and to combat anorexia by eating small, high-calorie, high-protein meals. (Protein intake should be reduced if signs or symptoms of pre-coma — lethargy, confusion, and mental changes — develop.) Large meals are usually better tolerated in the morning because many patients experience nausea late in the day.
In acute viral hepatitis, hospitalization usually is required only for the patient with severe symptoms or complications. Parenteral nutrition may be required if the patient experiences persistent vomiting and is unable to maintain oral intake.
Antiemetics may be given 30 minutes before meals to relieve nausea and prevent vomiting; phenothiazines have a cholestatic effect and should be avoided. For severe pruritus, the resin cholestyramine may be given.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hepatic encephalopathy:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment stops progression of encephalopathy by reducing blood ammonia levels. Treatment includes eliminating ammonia-producing substances from the GI tract by administering neomycin to suppress bacterial flora (preventing them from converting amino acids into ammonia), performing sorbitol-induced catharsis to produce osmotic diarrhea and continuous aspiration of blood from the stomach, and reducing dietary protein intake.
Lactulose, which traps ammonia in the bowel and promotes its excretion, is administered to reduce blood ammonia levels. Bacterial enzymes change lactulose to lactic acid, thereby rendering the colon too acidic for bacterial growth. At the same time, the resulting increase in free hydrogen ions prevents diffusion of ammonia through the mucosa; lactulose promotes conversion of systemically absorbable ammonia to ammonium, which is poorly absorbed and can be excreted. It’s usually given orally. However, if the patient is in a coma, it may be administered by retention enema.
Treatment may also include potassium supplements to correct alkalosis due to increased ammonia levels, especially if the patient is taking diuretics. Hemodialysis may sometimes be used to clear toxic blood temporarily. Salt-poor albumin may be used to maintain fluid and electrolyte balance, replace depleted albumin levels, and restore plasma. Sedatives, tranquilizers, and other medications metabolized or excreted by the liver should be avoided if possible. Medications containing ammonium (including certain antacids) should also be avoided.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Nonviral hepatitis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment must remove the causative agent by lavage, catharsis, or hyperventilation, depending on the route of exposure. Acetylcysteine may serve as an antidote for toxic hepatitis caused by acetaminophen poisoning but doesn’t prevent drug-induced hepatitis caused by other substances. Corticosteroids may be ordered for patients with the drug-induced type.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cirrhosis and fibrosis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment is designed to remove or alleviate the underlying cause of cirrhosis or fibrosis, prevent further liver damage, and prevent or treat complications. The patient may benefit from a high-calorie and moderate- to high-protein diet, but developing hepatic encephalopathy mandates restricted protein intake. In addition, sodium is usually restricted to 200 to 500 mg/day and fluids to 1 to 1½ qt (1 to 1.5 L)/day.
If the patient’s condition continues to deteriorate, he may need tube feedings or total parenteral nutrition. He may also need supplemental vitamins — A, B complex, D, and K — to compensate for the liver’s inability to store them and vitamin B12, folic acid, and thiamine for deficiency anemia. Rest, moderate exercise, and avoidance of exposure to infections and toxic agents are essential.
Drug therapy requires special caution because the cirrhotic liver can’t detoxify harmful substances efficiently. When absolutely necessary, vasopressin may be prescribed for esophageal varices, and diuretics may be given for edema. However, diuretics require careful monitoring because fluid and electrolyte imbalance may precipitate hepatic encephalopathy. Encephalopathy is treated with lactulose. Antibiotics are used to decrease intestinal bacteria and reduce ammonia production, which causes encephalopathy. Coagulopathy may be treated with blood products or vitamin K.
Low-protein diets are controversial. They aid in managing acute hepatic encephalopathy but are rarely necessary in chronic conditions because of the underlying protein-calorie malnutrition.
Paracentesis and infusions of salt-poor albumin, in addition to fluid and salt restriction, may alleviate ascites. Surgical procedures include treatment of varices by upper endoscopy with banding or sclerosis, splenectomy, esophagogastric resection, and splenorenal or portacaval anastomosis to relieve portal hypertension. (See Portal hypertension and esophageal varices, page 758, and Circulation in portal hypertension, page 759.)
Alert If cirrhosis progresses and becomes life-threatening, a liver transplant should be considered.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Hepatitis, viral:
Treatment
(Handbook of Diseases)
No specific drug therapy has been developed for hepatitis, with the exception of hepatitis C, which has been treated somewhat successfully with interferon alfa-2b and the more recently FDA-approved peginterferon alfa-2a. Instead, the patient is advised to rest in the early stages of the illness and to combat anorexia by eating small, high-protein meals.
Clinical tip The largest meal should be eaten in the morning because nausea tends to intensify as the day progresses.
Protein intake should be reduced if signs of precoma — lethargy, confusion, and mental changes — develop.
In acute viral hepatitis, hospitalization is usually required only for patients with severe symptoms (severe nausea, vomiting, change in mental status, and PT greater than 3 seconds above normal) or complications. Parenteral nutrition may be required if the patient experiences persistent vomiting and can’t maintain oral intake.
Antiemetics (diphenhydramine or prochlorperazine) may be given 30 minutes before meals to relieve nausea and prevent vomiting; phenothiazines have a cholestatic effect and should be avoided. For severe pruritus, the resin cholestyramine may be given.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Hepatic encephalopathy:
Treatment
(Handbook of Diseases)
Effective treatment stops the progression of encephalopathy by reducing blood ammonia levels. Such treatment eliminates ammonia-producing substances from the GI tract by:
❑ administration of lactulose to reduce the blood ammonia levels and use of sorbitol-induced catharsis to produce osmotic diarrhea; neomycin therapy may be added if lactulose alone doesn’t reduce ammonia levels
❑ reduction of dietary protein intake
❑ continuous aspiration of blood from the stomach.
Lactulose
Lactulose traps ammonia in the bowel and promotes its excretion. It’s effective because bacterial enzymes change lactulose to lactic acid, thereby rendering the colon too acidic for bacterial growth. At the same time, the resulting increase in free hydrogen ions prevents diffusion of ammonia through the mucosa; lactulose promotes conversion of systemically absorbable ammonia to ammonium, which is poorly absorbed and can be excreted.
The usual dosage of lactulose syrup is 30 to 45 ml by mouth (P.O.) three or four times daily. For acute hepatic coma, 300 ml of lactulose syrup diluted with 700 ml of water may be administered by retention enema. Lactulose therapy requires careful monitoring of fluid and electrolyte balance.
Neomycin
Neomycin is usually given in a dose of 3 to 4 g daily P.O. or by retention enema. Although neomycin is nonabsorbable at the recommended dosage, an amount that exceeds 4 g daily may produce irreversible hearing loss and nephrotoxicity after prolonged use.
Other treatments
Treatment may also include potassium supplements to correct alkalosis (from increased ammonia levels), especially if the patient is taking diuretics.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Hepatitis, nonviral:
Treatment
(Handbook of Diseases)
Effective treatment must remove the causative agent by lavage, catharsis, or hyperventilation, depending on the route of exposure. Acetylcysteine may serve as an antidote for toxic hepatitis caused by acetaminophen poisoning but doesn’t prevent drug-induced hep-atitis caused by other substances.
Corticosteroids may be prescribed for patients with drug-induced hepatitis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Cirrhosis:
Treatment
(Handbook of Diseases)
The goals of treatment include removing or alleviating the underlying cause of cirrhosis or fibrosis, preventing further liver damage, and preventing or treating complications.
Dietary measures
The patient may benefit from a high-calorie and moderate- to high-protein diet, but if the patient develops hepatic encephalopathy, protein intake must be restricted. In addition, sodium is usually restricted to 400 to 800 mg/day; fluids, to 1,000 to 1,500 ml/day.
If the patient’s condition continues to deteriorate, he may need tube feedings or hyperalimentation. Other supportive measures include supplemental vitamins — A, B complex, D, and K — to compensate for the liver’s inability to store them and vitamin B, folic acid, and thiamine for deficiency anemia. Rest, moderate exercise, and avoidance of exposure to infections and toxic agents are essential.
Drug therapy
With cirrhosis, drug therapy requires special caution because the cirrhotic liver can’t detoxify harmful substances efficiently. Alcohol is prohibited; sedatives should be avoided or prescribed with great care. Acetaminophen is especially hepatotoxic, particularly when combined with alcohol.
When absolutely necessary, an antiemetic, such as trimethobenzamide or benzquinamide, may be given for nausea; vasopressin, for esophageal varices; and a diuretic, such as furosemide or spironolactone, for edema. However, if the patient receives a diuretic, careful monitoring is necessary; fluid and electrolyte imbalance may precipitate hepatic encephalopathy.
Vitamin K may be given for bleeding tendencies due to hypoprothrombinemia. Transfusion of blood and fresh frozen plasma may also be necessary.
A beta-adrenergic blocker may be given to decrease pressure from varices.
Lactulose may be given orally or rectally to reduce a high ammonia level. If lactulose therapy alone is inadequate, neomycin may be used.
Other treatment
Paracentesis and infusions of salt-poor albumin may alleviate ascites. Surgical procedures include ligation of varices, splenectomy, esophagogastric resection, and splenorenal or portacaval anastomosis to relieve portal hypertension.
Clinical tip Transjugular intrahepatic portosystemic shunt is an alternative to surgical shunting in patients with variceal bleeding refractory to standard therapy. It’s also helpful in patients with severe ascites. The technique involves insertion of an expandable metal shunt between a branch of the hepatic vein and portal vein over a catheter inserted via the jugular vein. This is usually a bridging mechanism to control variceal bleeding or ascites until liver transplantation can be performed.
Hepatorenal and hepatopulmonary syndromes may occur. Treatment is ineffective except in patients who are acceptable candidates for liver transplantation.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Hepatitis:
Management
(Pediatric Infectious Disease)
Currently, there is no specific therapy for hepatitis infection. Treatment is
supportive.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Infectious Disease, 2004
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