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Hepatic Encephalopathy

Medically reviewed by Last updated on Jul 4, 2022.

What is hepatic encephalopathy (HE)?

HE is a brain condition that is caused by liver disease. Liver diseases such as cirrhosis prevent the liver from removing ammonia and other harmful substances from the blood. The harmful substances build up in the blood and prevent the brain from working correctly. Early treatment is needed to reverse the damaging effects of this condition and restore proper brain function.

What increases my risk for HE?

Any of the following may increase your risk for HE if you have a liver disease:

  • 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

How is HE diagnosed?

Your healthcare provider will examine you and do a neurological exam. 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. You may also need blood and urine tests to look for infection or test liver function. Healthcare providers may also use the tests to get information about your overall health.

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 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.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

View more treatment options

What can I do to manage HE?

  • Do not drink alcohol. Alcohol can worsen your condition. Alcohol can also cause new or worsening damage to your liver and brain.
  • Eat low-protein and low-sodium foods. You may be asked to eat less protein and sodium (salt). Some foods high in protein include beef, pork, poultry (chicken, turkey), beans, and nuts. Some foods high in sodium include salty snacks, canned foods, condiments, deli meats, and cured meat such as bacon. Ask your dietitian for more information about foods to limit or avoid.

Call 911 or have someone else call for any of the following:

  • You have a seizure.
  • You cannot be woken.

When should I seek immediate care?

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

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.

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 healthcare providers 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.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.