الفهرس 
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Abstract
The study included 120 patients diagnosed to have liver cirrhosis, presented to ICU by acute episode of hepatic encephalopathy either occurred spontaneously or precipitated by different precipitating factors. Different lines of treatment had been used included lactulose, L-ornathine L-aspartate, magnesium sulfate and either metronidazole or rifaximin. We assessed every patient before starting the treatment clinically and laboratory including venous blood ammonia level. And again we reassessed the patients 3 days after starting the treatment clinically and laboratory to judge the clinical improvement and the change in venous ammonia level.
The present study showed that rifaximin and metronidazole have been effective in management of an episode of overt hepatic encephalopathy in 75% and 76.67% of patients respectively without significant difference. A decrease in venous ammonia level was observed for both drugs but with no significant difference. In addition to that venous blood ammonia level was higher in all patients, but with no correlation to the grades of hepatic encephalopathy.
Also our results showed that the prevalence of hepatic encephalopathy was more in males than females which may be due to high prevalence of HCV infection within males. The most common precipitating factors are infections followed by diarrhea in (38.3%) and (19.2%) of patients respectively, they might be due to low host immunity. Other precipitating factors noted in our study were diuretics (14.1%), constipation (9.2%), high protein diet (8.3%), vomiting (5%), LVP (4.2%) and no obvious precipitating factors were found in (1.7%) of patients. The most common associated co-morbidity was diabetes mellitus in (15%) of patients followed by hypertension (7.5%), ischemic heart disease (4.2%) and chronic kidney disease (2.5%).
However in the present study all patients received oral non-absorbable disaccharides, oral or IV LOLA and magnesium sulfate enema in addition to rifaximin or metronidazole therefore the improvement in conscious level or ammonia level cannot be correlated to rifaximin and metronidazole effects alone and our results may be explained by the add on effect of both drugs in the treatment of hepatic encephalopathy.