Hepatic encephalopathy

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 18, 2016
StartDiseasesHepatic encephalopathy

Hepatic encephalopathy is a condition that results in loss of brain function, possibly leading to coma and death, that arises from damage to the liver.


Definition & Facts

The job of the liver is to remove toxins from the bloodstream, filtering them out before they can do damage. An impaired liver, however, cannot perform this duty, and the build up of toxic substances can cause potentially irreparable brain damage if not properly treated.

Most often, hepatic encephalopathy results from cirrhosis of the liver due to alcoholism. Nearly 70% of patients suffering from cirrhosis of the liver experience hepatic encephalopathy to some degree. Any number of stressors from dehydration to infection can burden the liver enough to create a buildup of toxins, inducing hepatic encephalopathy.

Symptoms & Complaints

In the early stages, the disease might be overlooked as the impairments are minor, and may include:

It is important to be mindful of the onset of these symptoms for those experiencing cirrhosis, as this could mean a worsening of the liver damage, or another underlying condition that needs attention. Left unabated, the hepatic encephalopathy can progress to more severe symptoms, such as:

Often these symptoms can cause significant impairment, rendering self-care of the patient impossible. Even before this occurs, the anxiety and depression associated with these diseases can cause considerable quality of life loss, and so proper health maintenance and addressing of symptoms related to mental disorders are extremely important.


The direct cause of hepatic encephalopathy is a damaged liver that cannot perform its function of filtering toxins out of the bloodstream. These toxins build up in parts of the brain, causing significant impairment and damage across a broad spectrum of functions, from speech and communication to walking and fine motor function.

Though the toxins will build up as cirrhosis or other liver diseases progress, hepatic encephalopathy can be acutely caused by several different factors, including but not limited to: dehydration, infection, drug use, kidney disease, certain medications, and surgery. Any one of these factors can occur with cirrhosis typically, and all can place undue strain on the liver, creating an environment in the blood that will trigger hepatic encephalopathy.

Diagnosis & Tests

A doctor treating a patient for cirrhosis will perform a physical examination and observe potential symptoms of hepatic encephalopathy, including musty breath, jaundice, shaking of hands or arms, confusion, difficulty with mental processes including thinking clearly, talking, or processing information.

Direct testing for hepatic encephalopathy includes blood counts, scans and EEGs to check for signal impairment in the brain and central nervous system in general, liver function tests, electrolyte imbalances, and BUN and creatinine levels to test for kidney function.

Testing for hepatic encephalopathy is primarily done to check for impairment and for toxic substances building up in the blood, like ammonia that would normally be filtered out by the liver.

Treatment & Therapy

Hepatic encephalopathy is a disease that can be life-threatening and often will require a medical visit or a hospital stay to get the patient stabilized and to remove the substances building up in the intestines. The primary focus of medical attention is identifying the immediate cause of the encephalopathy. For instance, if it is an infection, then antibiotics or antiviral drugs might be administered.

For dehydration or kidney impairment, fluids and electrolytes will be given. A recent history of exposure to toxins, food intake, drug or medicine usage can help the doctor make an informed course of action if there are no other overt signs of causation. There are also drugs that prevent gut bacteria from producing ammonia, and in some cases, antibiotics will be administered to reduce these bacteria, even if an actual infection isn't present to help relieve some of the stress on the liver.

In addition, avoiding medication - particularly sedatives - that require the liver to be broken down is recommended. Aspirin and some antacids can also be problematic, but there are alternatives that can be recommended by a doctor.

Prevention & Prophylaxis

Since hepatic encephalopathy is almost entirely caused by extensive liver damage, preventing that damage is critical and the first line of defense. For those who already have cirrhosis or another type of liver disease prevention of hepatic encephalopathy is based mostly on lifestyle choices.

Avoiding heavy drinking, particularly binge drinking, unprotected or risky sexual behaviors, and intravenous drug usage will all largely mitigate the chance of contracting hepatitis C which can cause cirrhosis, or the liver scarring associated with alcoholism.

Keeping properly hydrated, eating healthy, avoiding foods that promote ammonia buildup in the intestines, and being attentive to the signs of infection, are all ways to keep the stress off the liver and prevent the buildup of toxins such that the liver cannot clear them.

Being mindful of changes in personality, motor function, speech, or thinking are also important as these can translate into worsening of symptoms very rapidly if they are not addressed by medical professionals.