About Hepatic Encephalopathy (HE, Hepatic Coma)
Hepatic encephalopathy is a disorder that develops in the brain of some individuals as a result of liver disease. Reduced liver function can create disturbances in the central nervous system.
Why it is Problematic
Hepatic encephalopathy is a serious condition that has effects that may range from subtle to life threatening. Patients with hepatic encephalopathy are often unable to care for themselves. In prominent cases of hepatic encephalopathy, an individual can become unconscious, unresponsive, comatose, or may even die. The majority of individuals who go into a coma as a result of hepatic encephalopathy will die.
Causes and Risk Factors
The exact cause of hepatic encephalopathy is unknown. It may appear suddenly when liver damage occurs in individuals who had no previously known liver damage. More often, hepatic encephalopathy occurs in individuals with chronic liver disease and may be triggered by:
- Bleeding from intestines, stomach, or esophagus
- Eating too much protein
- Electrolyte abnormalities
- Immunosuppressant medication
- Kidney problems
- Low oxygen levels in the body
Some other conditions that resemble or hide hepatic encephalopathy are:
- Alcohol intoxication
- Complicated alcohol withdrawal
- Metabolic abnormalities such as low blood glucose
- Sedative overdose
- Subdural hematoma (bleeding under the skull)
- Wernicke-Korsakoff syndrome
Symptoms of hepatic encephalopathy may be mild at first. They may begin slowly and gradually worsen, or they may stay the same.
Common symptoms include:
- Change in sleep patterns
- Change in thinking
- Mental fog
- Mild confusion
- Musty or sweet breath
- Personality or mood changes
- Poor concentration
- Poor judgment
- Worsening of handwriting or other small movements
Severe symptoms include:
- Abnormal movements (shaking hands)
- Agitation, excitement, or seizures
- Drowsiness, confusion
- Inappropriate behavior
- Severe personality changes
- Slurred speech
- Slowed or sluggish movements
Doctors have many tests available to diagnose hepatic encephalopathy.
The presence of particular physical signs used in diagnosis may include:
- Examining the individual for "flapping,"the flapping-like shaking of hands when the individual is trying to hold arms out and in front of the body.
- Checking for signs of liver disease such as jaundice, ascites, dark urine, and musty breath.
- Checking for signs of an abnormal mental state, with a focus on cognitive tasks.
Diagnostic tests may include complete blood count, liver function tests, ammonia level testing, manganese level testing, a complete metabolic panel test ( specifically sodium, potassium, BUN and creatinine) and imagining tests.
Treatment and Prevention
Hepatic encephalopathy may be considered a medical emergency, depending on the severity of the symptoms. Seek immediate medical attention if you or someone you know experiences any of the symptoms of hepatic encephalopathy. Hospitalization may be required.
Treatment will focus on the root cause of hepatic encephalopathy such as:
- Treat electrolyte imbalances
- Stop gastrointestinal bleeding
- Support breathing and/or blood circulation
- Discuss the need to take medications as prescribed such as lactulose and rifaximim
- Avoid medications such as sedatives, tranquilizers, and other medications that broken down by the liver
Acute hepatic encephalopathy may be treatable. Recovery and risks will vary from patient to patient. The best course of treatment is prevention. Some ways to help prevent liver disease and damage are to:
- Avoid alcohol
- Avoid drugs and IV drug use
- Have only protected sex
- Vaccinate against hepatitis A and B
- Take only medication and herbal supplements only as recommended
- Avoid inhalation and skin absorption of toxins
Hepatic encephalopathy is most often seen in people with chronic liver disease with the accumulation of toxins built up in the body if the liver is not working well. It can occur suddenly in individuals with no previous liver problems if damage to the liver occurs.