Treatment:

Hepatic encephalopathy is an acute medical condition that may become a medical emergency. Hospitalization is required.

The goals of treatment include life support, elimination or treatment of the causes, and removal or neutralization of ammonia and other toxins. Life support may include support of breathing or blood circulation, particularly if coma develops. The brain may swell, which can be life-threatening.

Causes must be identified and treated. Gastrointestinal bleeding must be stopped. The intestines must be emptied of blood. Blood breaks down into protein parts that are converted to ammonia. Treatment of infections, kidney failure, and electrolyte abnormalities (especially potassium) is important.

In patients with severe, repeated cases of encephalopathy, the patient may be told to reduce protein in the diet to lower ammonia production. However, dietary counseling is important, as too little protein in the diet can contribute to malnutrition. Specially formulated intravenous or tube feedings may be necessary for critically ill patients.

Lactulose may be given to prevent intestinal bacteria from creating ammonia, and as a laxative to evacuate blood from the intestines. Neomycin may also be used to reduce ammonia production by intestinal bacteria. Rifaximin, a new antibiotic, is also effective in hepatic encephalopathy.

Sedatives, tranquilizers, and any other medications that are broken down or released by the liver should be avoided if possible. Medications containing ammonium (including certain antacids) should also be avoided. Other medications and treatments may be recommended, with variable results.

Expectations (prognosis):

Acute hepatic encephalopathy may be correctable, while chronic forms of the disorder often keep getting worse. Both forms may result in irreversible coma and death. Approximately 80% ( 8 out of 10 patients) die if coma develops. Recovery and the risk of repeated cases are variable.

Complications:

• Brain swelling
• Brain herniation
• Progressive, irreversible coma
• Permanent nervous system damage (to movement, sensation, or mental state)
• Increased risk of:
  • Sepsis
  • Respiratory failure
  • Cardiovascular collapse
  • Kidney failure
• Side effects of medications (see the specific medication)

Calling your health care provider:

Call your health care provider if any change in mental state or other neurological problem occurs, particularly if there is a known or suspected liver disorder. Hepatic encephalopathy can rapidly get worse and become an emergency condition!