Hepatic encephalopathy

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Digestive system organs

Hepatic encephalopathy

Alternative Names:

Hepatic coma; Encephalopathy - hepatic
Treatment:

Hepatic encephalopathy is an acute medical condition that may become a medical emergency. Hospitalization is required.

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The goals of treatment include life support, elimination or treatment of precipitating factors, and removal or neutralization of ammonia and other toxins. Life support may be required, including support of breathing or circulation, particularly if coma develops. The brain may develop swelling, which can be life-threatening.

Precipitating factors must be identified and treated. Gastrointestinal bleeding must be stopped. The intestines must be emptied of blood. Blood breaks down into protein components that are converted to ammonia. Treatment of infections, renal failure, and electrolyte abnormalities (especially potassium) is important.

In patients with severe, repeated cases of encephalopathy, the patient may be advised to reduce protein in the diet to reduce ammonia production. However, dietary counseling is important, as too little protein in the diet can contribute to malnutrition. Specially formulated intravenous or tube feedings may be necessary for critically ill patients.

Lactulose may be given to prevent intestinal bacteria from creating ammonia, and as a laxative to evacuate blood from the intestines. Neomycin may also be used to reduce ammonia production by intestinal bacteria.

Sedatives, tranquilizers, and any other medications that are metabolized or excreted by the liver should be avoided if possible. Medications containing ammonium (including certain antacids) should also be avoided. Other medications and treatments may be recommended, with variable results.

Expectations (prognosis):

Acute hepatic encephalopathy may be reversible, while chronic forms of the disorder are often progressive. Both forms may result in irreversible coma and death, with approximately 80% fatality if coma develops. Recovery and recurrence are variable.

Complications:

cerebral edema (brain swelling)
brain herniation
progressive, irreversible coma
permanent neurologic losses (movement, sensation, or mental state)
increased risk of:
- sepsis
- respiratory failure
- cardiovascular collapse
- kidney failure
side effects of medications (see the specific medication)

Calling your health care provider:

Call your health care provider if any change in mental state or other neurologic problem occurs, particularly if there is a known or suspected liver disorder. Hepatic encephalopathy can rapidly progress to become an emergency condition!