Hepatic Encephalopathy
Hepatic encephalopathy is impaired brain function associated with advanced liver disease or diversion of blood around the liver. It ranges from subtle changes in attention or sleep to severe confusion and coma.
Key points
- New confusion in someone with liver disease is urgent because infection, bleeding, dehydration or medicine effects may be the trigger.
- Treatment addresses both the precipitating problem and toxin production in the gut.
- Ammonia results alone do not diagnose or grade an episode; the clinical change matters most.
A listing cannot confirm hepatic encephalopathy or exclude another cause of altered consciousness, such as stroke, low glucose or sepsis.
What can trigger an episode?
Gastrointestinal bleeding, infection, constipation, dehydration, kidney problems and sedating medicines are common triggers. Clinicians assess mental state and signs of decompensated liver disease while looking actively for these reversible causes.
What role do gut-directed medicines have?
Rifaximin alters ammonia-producing gut bacteria and may reduce recurrence, commonly alongside another gut-directed treatment. It does not correct infection, bleeding or dehydration. See antibiotics for class context.
When to seek urgent care
Seek emergency care for new or worsening confusion, unusual behaviour, inability to stay awake, seizures, vomiting blood, black stool, fever or a rapid mental-state change. Do not let an affected person drive.