J Korean Med Sci.  2005 Feb;20(1):150-152. 10.3346/jkms.2005.20.1.150.

Neostigmine for the Treatment of Acute Hepatic Encephalopathy with Acute Intestinal Pseudo-obstruction in a Cirrhotic Patient

• Park CH
• Joo YE
• Kim HS
• Choi SK
• Rew JS
• Kim SJ

• KMID: 1781744
• DOI: http://doi.org/10.3346/jkms.2005.20.1.150

Abstract

We treated a 49-yr-old man with neostigmine, who had liver cirrhosis, acute hepatic encephalopathy, and acute intestinal pseudoobstruction. He was admitted in a state of hepatic confusion. On physical examination, the abdomen was distended; and bowel sound was absent. Plain abdomen film revealed multiple airfluid levels and distention of bowel loops. Initially, we gave him lactulose enemas every 6 hr for one day without improvement in his mental state. Furthermore, he became to a state of coma. Therefore, we gave him 0.5 mg of neostigmine subcutaneously to improve his peristaltic movement, and 2 L of polyethylene glycol electrolyte solution through a nasogastric tube for 4 hr to reduce the production and absorption of gutderived toxins of nitrogenous compounds. After these treatments, the venous ammonia level decreased to the normal range within 12 hr, and the coma disappeared after 2 days. We suggest that neostigmine may be one of the most effective treatments to initiate peristaltic movement and bowel cleansing in cirrhotic patients with acute hepatic encephalopathy and acute intestinal pseudoobstruction.

Keyword

Hepatic Encephalopathy; Liver Cirrhosis; Intestinal Pseudo-Obstruction; Neostigmine

MeSH Terms

Air
Ammonia/metabolism
Blood Pressure
Cholinesterase Inhibitors/*pharmacology
Electrolytes/pharmacology
Enema
Fibrosis/*drug therapy
Hepatic Encephalopathy/*diagnosis/*drug therapy/radiography
Humans
Intestinal Pseudo-Obstruction/*diagnosis/*drug therapy/radiography
Lactulose/pharmacology
Liver/metabolism
Male
Middle Aged
Neostigmine/*pharmacology
Peristalsis
Polyethylene Glycols/pharmacology
Time Factors

Figure

• 

  Fig. 1 Plain abdomen (upright film) reveals multiple air-fluid levels, distention of bowel loops, and presence of bowel gas in the left lower quadrant of the abdomen.

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  Fig. 2 Two days after the use of neostigmine and polyethylene glycol electrolyte solution, plain abdomen (upright film) shows only colonic gas without an air-fluid level.

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