Hepatic Encephalopathy

Written by April Kahn | Published on June 25, 2012
Medically Reviewed by Brenda B. Spriggs, MD, MPH, FACP

What Is Hepatic Encephalopathy?

Hepatic encephalopathy is a deterioration of brain function that is a serious complication of liver disease. In this condition, the liver is not removing toxins from the blood. This results in a buildup of toxins in the bloodstream that can cause brain damage. This condition can be acute or chronic. In some cases, a person with hepatic encephalopathy may become unresponsive and slip into a coma.

Acute hepatic encephalopathy develops because of serious liver disease. According to the Canadian Liver Foundation, this condition mainly occurs in people with: 

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

Acute hepatic encephalopathy also indicates terminal liver failure.

Chronic hepatic encephalopathy may be permanent or recurrent. Permanent cases are seen in people who are unresponsive to treatment and have permanent neurological abnormalities. This condition is rare. Recurrent cases are seen in people with severe cirrhosis (scarring of the liver).

What Causes Hepatic Encephalopathy?

The exact cause of hepatic encephalopathy is not known. It is brought on by a buildup of toxins in the bloodstream and occurs when the liver fails to function properly.

The liver removes toxic chemicals 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 the urine. When the liver is damaged, it is unable to filter out all the toxins. When the kidneys cannot complete this process, toxins build up in the bloodstream. Toxic buildup can damage the organs and nerves.

Hepatic encephalopathy may be triggered by:

  • infections
  • kidney problems
  • dehydration
  • low oxygen levels
  • recent surgery
  • use of medications to suppress the immune system
  • eating too much protein
  • use of medications like 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 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
  • anxiety
  • seizures
  • severe personality changes
  • fatigue
  • confused speech
  • shaky hands
  • slow movements

If you develop symptoms of severe hepatic encephalopathy, seek medical attention immediately. These symptoms can lead to a coma if not treated promptly. If you see a person having a seizure or if they become unconscious or unresponsive, call 911.

How Is Hepatic Encephalopathy Diagnosed?

Several tests are used to diagnose hepatic encephalopathy.

Blood Tests

A complete blood count may be used to check your red blood cell count, white blood cells, and platelets. A low red blood cell count indicates blood loss and a lack of adequate 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 consistent with impaired liver function.

Imaging Tests

An imaging test, such as a 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 from your liver. An increase in enzymes indicates stress on the liver or liver damage.

If you have kidney disease or liver disease, tell your doctor. 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 of the condition.

In severe cases, the person may have difficulty breathing and would need the help of a ventilator or oxygen delivered through a mask.

If eating too much protein brought on the condition, a reduced amount of dietary protein is strongly recommended. Since protein is necessary for the body to function properly, a dietician or doctor can craft a diet that will allow you to get an adequate amount of protein without causing or worsening symptoms of hepatic encephalopathy. Foods to be avoided are those that have a high protein content such as poultry, meat, eggs, and fish.

Medications can help slow the rate at which toxins are absorbed into the blood. Lactulose, a synthetic sugar, may be prescribed. It can draw ammonia created by your intestinal bacteria from your blood into the colon, where it can be removed from your body.

What Is the Long-Term Outlook for Hepatic Encephalopathy?

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

Complications may be irreversible. They 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. Steps that can be taken to prevent liver disease include:

  • avoid drinking alcohol, or consume alcohol in moderation
  • avoid high-fat foods
  • lose excess weight and maintain a healthy weight
  • don’t use drugs and don’t share needles

You should also take steps to avoid contracting viral hepatitis, such as:

  • washing your hands well after using the bathroom or changing a diaper
  • not sharing needles
  • avoiding close contact with someone diagnosed with viral hepatitis
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