Hepatic Encephalopathy: Symptoms, Stages, and Outlook

Acute hepatic encephalopathy develops because of severe liver disease. This mainly occurs in people with these conditions:

• Acute fulminant viral hepatitis. This is a severe type of viral hepatitis that comes on suddenly.
• Toxic hepatitis. Toxic hepatitis may be caused by exposure to alcohol, chemicals, drugs, or supplements.
• Reye’s syndrome. This rare and serious condition is primarily seen in children. It causes sudden swelling and inflammation of the liver and the brain.

Acute hepatic encephalopathy may also be a sign of terminal liver failure.

Chronic hepatic encephalopathy may be permanent or recurrent.

Those with the recurrent version will have multiple episodes of hepatic encephalopathy throughout their lives. They’ll also require continuous treatment to help prevent the development of symptoms. Recurrent cases are usually seen in people with severe cirrhosis, or scarring of the liver.

Permanent cases are rare and seen in people who don’t respond to treatment and who have permanent neurological conditions, such as:

• seizure disorder
• spinal cord injury

Symptoms of hepatic encephalopathy differ depending on the underlying cause of the liver damage.

Symptoms and signs of moderate 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 or lethargy
• anxiety
• seizures
• severe personality changes
• fatigue
• confused speech
• shaky hands
• slow movements

Get emergency medical help right away if you develop symptoms of severe hepatic encephalopathy. These symptoms can lead to a coma if they’re not treated quickly.

The exact cause of hepatic encephalopathy is unknown. However, it’s usually triggered by a buildup of toxins in the bloodstream. This occurs when your liver fails to break down toxins properly.

Your liver removes toxic chemicals such as ammonia from your body. These toxins are left over when proteins are metabolized or broken down for use by various organs in your body. Your kidneys change these toxins into safer substances that are then removed through urination.

When your liver is damaged, it’s unable to filter out all the toxins. Toxins can then build up in your bloodstream and potentially get into your brain. Toxic buildup can also damage other organs and nerves.

Hepatic encephalopathy may be triggered by:

• infections such as pneumonia
• kidney problems
• dehydration
• hypoxia, or low oxygen levels
• recent surgery or trauma
• medications that suppress your immune system
• eating too much protein
• medications that suppress your central nervous system, such as barbiturates or benzodiazepine tranquilizers
• electrolyte imbalance, especially a decrease in potassium after vomiting or taking diuretics

Several tests are used to diagnose hepatic encephalopathy.

Blood tests

A complete blood count checks your red blood cells, white blood cells, and platelets. A low red blood cell count indicates blood loss and a lack of oxygen.

Blood tests may also be used to check your blood levels of sodium, potassium, and ammonia. Having too much of these substances is a sign of 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 check for raised enzyme levels. An increase in enzymes indicates stress on your liver or liver damage.

Tell your doctor if you have kidney disease or liver disease. The symptoms you’re experiencing along with your medical history can sometimes be enough to diagnose hepatic encephalopathy.

Hepatic encephalopathy is divided into stages based on the severity of the symptoms. Common classification systems include the West Haven Criteria and the Glasgow Coma Scale.

The five stages of hepatic encephalopathy, according to the West Haven Criteria, are:

• Stage 0. At this stage, symptoms are minimal.
• Stage 1. Symptoms are mild. They may include a shortened attention span and changes to your sleep habits, such as hypersomnia or insomnia.
• Stage 2. Symptoms are moderate. At this stage, you may feel disoriented or lethargic.
• Stage 3. Symptoms are severe. You’ll be unable to perform basic tasks. You’ll also feel confused and experience personality changes.
• Stage 4. This stage is characterized by coma.

Treatment options for hepatic encephalopathy depend on the severity and underlying cause of the condition.

You’ll likely need to eat less protein if eating too much protein caused the condition. Since protein is necessary for your body to function properly, a dietician or doctor can create a diet that’ll allow you to get enough protein without making your symptoms worse. High-protein foods to avoid include:

• poultry
• red meat
• eggs
• fish

Medications can also help slow the rate at which your blood absorbs toxins. Your doctor may prescribe antibiotics and lactulose (Enulose), a synthetic sugar. These medications can draw ammonia, created by intestinal bacteria from your blood, into your colon. Your body will then remove the blood from your colon.

In severe cases that cause difficulty breathing, a ventilator or oxygen mask may be necessary.

Some people with the condition may be eligible to receive a liver transplant.

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

Hepatic encephalopathy and its symptoms can be reversible with proper treatment.

Complications that may be irreversible include:

• brain herniation
• brain swelling
• organ failure

The best way to prevent hepatic encephalopathy is to prevent or manage liver disease. You can lower your chances of getting liver disease by taking these steps:

• Avoid alcohol or consume it in moderation.
• Avoid high-fat foods.
• Maintain a healthy weight.
• Don’t share contaminated needles.

To avoid getting viral hepatitis:

• Wash your hands well after using the bathroom or changing a diaper.
• Don’t share contaminated needles.
• Avoid close contact with people diagnosed with viral hepatitis.
• Get vaccinated against hepatitis A and hepatitis B.