Hepatic Encephelopathy

Hepatic encephalopathy is a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood.


Hepatic encephalopathy is caused by disorders that affect the liver. These include disorders that reduce liver function (such as cirrhosis or hepatitis) and conditions in which blood circulation does not enter the liver. The exact cause of hepatic encephalopathy is unknown.

An important job of the liver is to change toxic substances that are either made by the body or taken into the body (such as medicines) and make them harmless. However, when the liver is damaged, these "poisons" may build up in the bloodstream.

Ammonia, which is produced by the body when proteins are digested, is one of the harmful substances that is normally made harmless by the liver. Many other substances may also build up in the body if the liver is not working well. They can cause damage to the nervous system.

Hepatic encephalopathy may occur suddenly in people who previously had no liver problems when damage occurs to the liver. More often, the condition is seen in people with chronic liver disease.

Hepatic encephalopathy may be triggered by:
  • Dehydration
  • Eating too much protein
  • Electrolyte abnormalities (especially a decrease in potassium) from vomiting, or from treatments such asparacentesis or taking diuretics ("water pills")
  • Bleeding from the intestines, stomach, or esophagus
  • Infections
  • Kidney problems
  • Low oxygen levels in the body
  • Shunt placement or complications (See: Transjugular intrahepatic portosystemic shunt )
  • Surgery
  • Use of medications that suppress the central nervous system (such as Disorders that can mimic or mask symptoms of hepatic encephalopathy include:
  • Alcohol intoxication
  • Complicated alcohol withdrawal
  • Meningitis
  • Metabolic abnormalities such as low blood glucose
  • Sedative overdose
  • Subdural hematoma (bleeding under the skull)
  • Wernicke-Korsakoff syndrome

Heptic encephalopathy may occur as an acute, potentially reversible disorder. Or it may occur as a chronic, progressive disorder that is associated with chronic liver disease.


Symptoms many begin slowly and gradually worsen, or they may begin suddenly and be severe from the start.Symptoms may be mild at first.

Family members or caregivers may notice that the patient has:
  • Breath with a musty or sweet odor
  • Change in sleep patterns
  • Changes in thinking
  • Confusion that is mild
  • Forgetfulness
  • Mental fogginess
  • Personality or mood changes
  • Poor concentration
  • Poor judgment
  • Worsening of handwriting or loss of other small hand movements
More severe symptoms may include:
  • Abnormal movements or shaking of hands or arms
  • Agitation, excitement, or seizures (occur rarely)
  • Disorientation
  • Drowsiness or confusion
  • Inappropriate behavior or severe personality changes
  • Slurred speech
  • Slowed or sluggish movement

Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a coma.

Patients with hepatic encephalopathy are often not able to care for themselves because of these symptoms.