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Hepatic Encephalopathy

What Is Hepatic Encephalopathy?

Hepatic encephalopathy is a decline in brain function that occurs as a result of severe liver disease. In this condition, the liver cannot adequately remove toxins from the blood. This causes a buildup of toxins in the bloodstream, which can lead to brain damage.

Hepatic encephalopathy can be acute (short-term) or chronic (long-term). In some cases, a person with hepatic encephalopathy may become unresponsive and slip into a coma.

Acute hepatic encephalopathy develops because of severe liver disease. This condition mainly occurs in people with:

  • acute fulminant viral hepatitis: a severe type of viral hepatitis that comes on suddenly
  • toxic hepatitis: may be caused by exposure to alcohol, chemicals, drugs (recreational or prescription), or supplements
  • Reye’s syndrome: a rare and serious condition primarily seen in children that causes sudden swelling and inflammation of the liver and brain

Acute hepatic encephalopathy may also be a sign of terminal liver failure.

Chronic hepatic encephalopathy may be permanent or recurrent. Those with the recurrent version will have multiple episodes of hepatic encephalopathy throughout their lives. They will also require continuous treatment to help prevent the development of symptoms. Recurrent cases are usually seen in people with severe cirrhosis (scarring of the liver).

Permanent cases are seen in people who don’t respond to treatment and who have permanent neurological conditions, such as a seizure disorder or a spinal cord injury. This condition is rare.

What Causes Hepatic Encephalopathy?

The exact cause of hepatic encephalopathy is unknown. However, it’s usually triggered by a buildup of toxins in the bloodstream. This occurs when the liver fails to break down toxins properly.

The liver removes toxic chemicals such as ammonia from the body. These toxins are left over from proteins that are metabolized or broken down for use by various organs in the body. The kidneys change these toxins into safer substances that are then removed from the body through urination.

When the liver is damaged, it’s unable to filter out all the toxins. Toxins can then build up in the bloodstream and potentially get into the brain. Toxic buildup can also damage other organs and nerves.

Hepatic encephalopathy may be triggered by:

  • Infections such as pneumonia
  • kidney problems
  • dehydration
  • low oxygen levels (hypoxia)
  • recent surgery or trauma
  • use of medications to suppress the immune system
  • eating too much protein
  • use of medications (such as barbiturates or benzodiazepine tranquilizers) that suppress the central nervous system
  • electrolyte imbalance, especially a decrease in potassium after vomiting or taking diuretics

What Are the Symptoms of Hepatic Encephalopathy?

Symptoms of hepatic encephalopathy differ depending on the underlying cause of the liver damage.

Symptoms and signs of moderate hepatic encephalopathy may include:

  • difficulty thinking
  • personality changes
  • poor concentration
  • problems with handwriting or loss of other small-hand movements
  • confusion
  • forgetfulness
  • poor judgment
  • a musty or sweet breath odor

Symptoms of severe hepatic encephalopathy are:

  • confusion
  • drowsiness or lethargy
  • anxiety
  • seizures
  • severe personality changes
  • fatigue
  • confused speech
  • shaky hands
  • slow movements

Go to the emergency room or call 911 right away if you develop symptoms of severe hepatic encephalopathy. These symptoms can lead to a coma if they’re not treated quickly.

How Is Hepatic Encephalopathy Diagnosed?

Several tests are used to diagnose hepatic encephalopathy.

Blood Tests

complete blood count may be used to check your red blood cells, white blood cells, and platelets. A low red blood cell count indicates blood loss and a lack of oxygen.

Blood tests may also be used to check the sodium, potassium, and ammonia levels in your blood. Having too much of these substances in the blood is a sign of impaired liver function.

Imaging Tests

An imaging test, such as a head CT scan or MRI, can check for bleeding in your head or abnormalities in your brain.

Liver Function Tests

Liver function tests may be given to check for raised enzyme levels. An increase in enzymes indicates stress on the liver or liver damage.

Tell your doctor if you have kidney disease or liver disease. The symptoms you’re experiencing along with your medical history can sometimes be enough to diagnose hepatic encephalopathy.

What Are the Treatment Options for Hepatic Encephalopathy?

Treatment options for hepatic encephalopathy differ depending on the severity and underlying cause of the condition.

You will likely need to eat less protein if eating too much protein caused the condition. Since protein is necessary for the body to function properly, a dietician or doctor can create a diet that will allow you to get enough protein without making your symptoms worse. High-protein foods to avoid include poultry, red meat, eggs, and fish.

Medications can also help slow the rate at which your blood absorbs toxins. Your doctor may prescribe antibiotics and lactulose (a synthetic sugar). These medications can draw ammonia that intestinal bacteria from your blood creates into the colon, where your body will remove it.

In severe cases that cause difficulty breathing, a ventilator or oxygen delivered through a mask may be necessary.

What Is the Long-Term Outlook for Hepatic Encephalopathy?

People with chronic hepatic encephalopathy have better recovery rates than those with the acute version of the condition. The rate of recovery increases if treatment is given before the condition gets worse.

Complications that may be irreversible include:

  • brain herniation
  • brain swelling
  • organ failure

Can Hepatic Encephalopathy Be Prevented?

The best way to prevent hepatic encephalopathy is to prevent or manage liver disease. You can lower your chances of getting liver disease by taking these steps:

  • Avoid drinking alcohol, or consume alcohol in moderation.
  • Avoid high-fat foods.
  • Lose excess weight and maintain a healthy weight.
  • Don’t use drugs or share needles.

To avoid getting viral hepatitis:

  • Wash your hands well after using the bathroom or changing a diaper.
  • Don’t share needles.
  • Avoid close contact with people diagnosed with viral hepatitis.

Content licensed from:

Written by: April Kahn
Medically reviewed on: Dec 01, 2015: Steve Kim, MD

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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