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Hepatic Encephalopathy


What is hepatic encephalopathy?

Hepatic encephalopathy (HE) is a brain condition that is caused by liver disease. Early treatment is needed to reverse the damaging effects of this condition and restore proper brain function.

What causes HE?

Liver diseases such as cirrhosis prevent the liver from removing ammonia and other harmful substances from the blood. These harmful substances then travel to the brain and other parts of the body and cause health problems. Any of the following may increase your risk for HE:

  • Diarrhea, constipation, and vomiting
  • Gastrointestinal bleeding
  • A high-protein diet
  • Infections caused by bacteria or a virus
  • Medicines such as sedatives and opioids

What are the signs and symptoms of HE?

At first, you may have only mild symptoms. Over time, you may develop more severe symptoms:

  • Mood changes, a short attention span, and drowsiness
  • Confusion and forgetfulness
  • Changes in sleeping habits and difficulty with speaking or writing
  • A musty, sweet odor to your breath
  • Flapping motion of your hands when your arms are outstretched
  • Sleepiness and decreased awareness
  • Coma

How is HE diagnosed?

  • Blood and urine tests may be done to look for infection or to test liver function. Healthcare providers may also use the tests to get information about your overall health.
  • An EEG is also called an electroencephalogram. Small pads or metal discs are put on your head. Each has a wire that is hooked to a machine. This machine prints a paper tracing of brain wave activity from different parts of your brain. Healthcare providers look at the tracing to see how your brain is working.
  • A neurologic exam can show healthcare providers how well your brain works after an injury or illness. Healthcare providers will check how your pupils react to light. They may check your memory and how easily you wake up. Your hand grasp and balance may also be tested.

How is HE treated?

  • For mild hepatic encephalopathy, you may only need a low-protein diet. A high-protein diet increases the amount of ammonia in your blood and may worsen the disease. You may also need to limit sodium (salt).
  • You may also be given medicine to increase bowel movements. Medicines may help reduce the amount of ammonia and other toxins that your body absorbs.
  • You may need to be in the hospital if you have severe HE. A machine called a ventilator may be used to help you breathe better. Artificial liver support to clean the blood may also be used. Surgery to correct blood flow to the liver or a liver transplant may be needed.

When should I contact my healthcare provider?

  • You have a fever.
  • You are sleeping more than usual.
  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • You had a seizure.
  • You feel confused, dizzy, or lightheaded.
  • Your heart is beating faster than is normal for you.
  • You have sudden shortness of breath.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.