- New or rapidly worsening confusion or reduced consciousness.
- Fever or suspected infection in a patient with ascites or advanced liver disease.
- Vomiting blood or black stools.
- Rapidly increasing abdominal swelling or severe abdominal pain.
- Rapidly worsening jaundice or other significant deterioration.
Hepatic Encephalopathy: Symptoms, Triggers & Treatment
Hepatic encephalopathy is primarily a clinical diagnosis. The priority is to identify and treat precipitating factors and then use appropriate therapy to reduce recurrence.
Recognize Changes
Confusion, drowsiness, altered behaviour or reduced alertness can occur.
Look for Triggers
Infections, gastrointestinal bleeding, constipation, dehydration, electrolyte abnormalities and medication-related factors may precipitate episodes.
Clinical Assessment
New altered mental status in a person with liver disease should be assessed carefully because not every episode of confusion is hepatic encephalopathy.
Lactulose
Lactulose is commonly used as first-line therapy and is adjusted according to clinical response.
Rifaximin
Rifaximin may be added for persistent or recurrent episodes despite appropriate lactulose therapy.
Prevent Recurrence
Follow-up focuses on identifying triggers, medication adherence and preventing repeated episodes.
