hepatic encephalopthy

Hepatic Encephalopahty is serious condition of the brain, neurologic changes, seen in some patients with severe  Liver Disease (Most common) as well as other causes.

Can be a Chronic or an Acute finding.

Condition or Symptoms are often reversible if treated appropriately, however the liver failure may not be.

It can also be seen in Portal Hypertension and shunting of blood away from the Liver.

Ammonia is primarily responsible for the symptoms but other toxins can be seen as well.

The liver becomes unable to properly decontaminate the blood.

Ammonia is able to cross the blood brain barrier.

This toxin then causes Inflammation to occur in the Brain.

Other causes other then liver disease:

  • Medications:  (Narcotics, Diuretics, Diazepam, Lorazepam)
  • Alcohol
  • Infection
  • Renal Failure
  • Hypokalemia –  *Low potassium in blood
  • Hyponatremia – *Low sodium in blood
  • Hypoglycemia  – *Low sugar in blood
  • Dehydration


  • Changes in memory and personality
  • Difficulty to concentrate and slowed reaction time
  • Tremor  (Asterixis)
  • Seizures
  • Agitation
  • Coma
  • Swelling in the brain
  • Changes in speech
  • Death can occur



Subclinical – Subtle changes
Stage 1 –  Tremor, incoordination, apraxia
Stage 2 –  Asterisix slowed or slurred speech, Ataxia
Stage 3 –   Hypoactive reflexes, nystagmus, clonus, muscular rigidity
Stage 4 –   Coma, dilated pupils, absence of response to stumuli



  • Decrease protein intake  [This will decrease amount of ammonia]
  • Correct Hypokalemia, Hyponatremia, and Hypoglycemia
  • Lactulose – helps decrease ammonia amounts
  • Rifaximin  [Antibiotics]
  • Treat liver disease
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