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Advice about recurring high ammonia levels

My father was diagnosed with end-stage liver disease, cirrhosis, and hepatic encephalopathy about 5 years ago.  He was pretty stable until last Christmas, and his health has seriously declined since then.  We are having a really hard time keeping his ammonia levels under control, despite following his liver doctor's orders to the letter.  He is normally on 3/x daily of 30 m/l lactulose, and when his ammonia ticks up (as we can tell from increased cognitive impairment, decline of motor skills, etc.), we provide it to him every 2-3 hours until symptoms improve.  Except that they often don't.  He went back in the hospital yesterday for the 10th time this year, because his ammonia levels got so high that he couldn't talk, walk, swallow.  We don't know what else to do to manage his condition.  Any advice or similar experience would be appreciated.
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Avatar universal
Would also add: he no longer drinks, has to get regular fluid pulls to treat ascites, severe muscle wasting, other general poor health conditions (cuts/bruises, delicate skin, etc.).
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683231 tn?1467323017
Is he eligible for a liver transplant and has he bern evaluated and placed on the list?

It sounds like he has very advanced liver disease and really the only treatment that will improve his health in any real way may be a transplant. Everything else is just management of symptoms as they arise

Which I had better news. He needs to be under the care of a hepatologist associated with a transplant center. Hopefully that is the kind of doctor he is seeing.
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Thank you - yes, he is under the care of a wonderful hepatologist associated with a transplant hospital.  He is not currently eligible for transplant because he never completed rehab, and it may be too late but is something his care team is currently evaluating.  It's really the short-term regulation of ammonia that we have found so debilitating.  His hepatologist (and everyone else at the hospital each time he goes) remarks that the high and regular doses of lactulose he gets around the clock should be enough.  The hospital struggles to get it under control each time he is admitted, so obviously we have a hard time at home as well.  Just wondering if anyone has any experience treating high ammonia with anything other than/in addition to lactulose and xifaxin (liver antibiotic I think?).
Xifaxin is not a liver antibiotic.

Xifaxan (rifaximin) is an antibiotic that fights bacterial infection only in the intestines. ... Xifaxan is also used to treat irritable bowel syndrome (IBS) in adults whose main symptom is diarrhea. Xifaxan is also used to lower the risk of a decline in brain function in adults with liver failure.
Avatar universal
Xifaxan.   Ask your doctor.  Eliminated the need for lactulose for me.
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They are giving him both Lactulose and Xifaxan per the last comment by the OP
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317787 tn?1473358451
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