What is commonly used to treat hepatic encephalopathy in fulminant hepatitis?

Lactulose is commonly used to treat hepatic encephalopathy, particularly in cases of fulminant hepatitis. This condition is characterized by the accumulation of ammonia and other toxins in the bloodstream due to impaired liver function, leading to confusion, altered levels of consciousness, and other neurological symptoms.

Lactulose is a non-absorbable disaccharide that works in the gut by drawing water into the bowel and promoting the excretion of ammonia. It not only reduces the absorption of ammonia from the intestines but also enhances its elimination through bowel movements. Additionally, lactulose can alter the gut flora by acidifying the colonic contents, which further diminishes the production of ammonia by bacterial metabolism.

While other treatments may be beneficial in managing related symptoms or underlying conditions—spironolactone is a diuretic used for fluid retention, propranolol is a beta-blocker for portal hypertension, and acetaminophen is generally avoided in liver failure due to potential hepatotoxicity—none are specifically indicated for the treatment of hepatic encephalopathy like lactulose. Thus, it stands out as the primary treatment option in this scenario.