High ammonia levels

This is my first time on here. My husband and I were told in 2008 that he was in stage 4 of cirrhosis. He was in the hospital 2 times in 2009 with bleeding problems. He has received platelets and blood. But our newest problem that I was really hoping that someone may be able to give me suggestions on is the fact that he was stable for well over a year. So the doctor finally agreed to let him have arthroscopic surgery on his knee. Since that surgery his ammonia has been thrown out of control. I had to call an ambulance to come get him because he wasn't responsive and his level was 110. By the next morning they had it down to 64. So they sent him home with taking lactulose 2x a day and the xifaxan 2x a day. Well 3 days later we went to the dr for a recheck and his ammonia was at 107. At this point he had finished the xifaxan cause they only wanted him to take it for 3 days. So at this point they tell us to do the lactulose 3x a day for 3 days, so then we went back and now his ammonia is at 109. Does anyone have any suggestions on anything that I can do to help. Maybe change his diet or something. I can't stand feeling so helpless. I felt helpless like this in 2009 when he was going through so much because the same year my mother was diagnosed with brain cancer and she was in the hospital constantly. My hands were tied with her because there was nothing I could do except love her and make her as comfortable as possible. She only lived 7 months after being diagnosed. So if there is anything and I mean anything that I can do for him please someone just let me know. I would be so grateful. Thank you.

Post Edited By Moderator (hep93) : 6/11/2013 10:57:21 PM (GMT-6)

Welcome to the forum, all4mercy. I agree with Rick. He needs to be taking the Lactulose as directed. If that doesn't work, you can increase it at will. He won't overdose on it. You might also try increasing the amount he is taking. If it's one Tbsp.., increase it to 2 T. at a time. He should be having up to 6 or more loose bowel movements a day. There is no need to run to the doctor everytime he exhibits encephalpathy (an indication of high ammonia.) Of course, if he is unresponsive, that's a different matter. They probably stopped the Xifaxan because it is expensive. Ask for an Rx when he is discharged. Have his primary care doc or hepatologist write a letter stating that he needs this med and can't afford it. This should be mailed with the Rx. (It can run up to $1400 a mo. w/o insurance.) I recently started a thread on help with meds. There is also specific info about help with Xifaxan from the manufacturer in the Hepatitis Resources folder, near the bottom of the page.

There is a lot of good info in that folder, including a medical words list (including some regular words) with the correct spellings. I corrected some of your medication misspellings and the name of the surgical procedure on his knee.

Do you know what his cirrhosis is from?

As for diet, he should not eat red meat. It's the most difficult protein for the liver to process. He should also eat lots of fresh or frozen fruit and veggies. Keep sodium to a minimum, which means no canned or processed foods. If kidney, garbanzo, white or black beans are used, rinse thoroughly in a colander before using. Keeping a liver friendly diet can stop or slow the progression of cirrhosis, though nothing but transplant can cure it.

I am going to delete your other thread/post, since it is a duplication of this one.

Hugs,
Connie