Hepatic encephalopathy: what it looks like and what to do
Ever wonder why severe liver disease can make someone confused or sleepy? Hepatic encephalopathy (HE) is a brain problem caused by a failing liver. When the liver can’t clean toxins from the blood, those toxins affect brain function. HE ranges from mild mood or sleep changes to serious confusion and even coma. Knowing the signs and quick steps to take can make a big difference.
What causes it and who gets it
HE most often happens in people with advanced liver disease—cirrhosis, hepatitis, or blocked bile flow. The main offender is ammonia, which builds up when the liver can’t process protein waste. Other triggers can kick off an episode: infection, gastrointestinal bleeding, dehydration, certain drugs (especially sedatives and opioids), constipation, or heavy alcohol use. If you or a family member has liver disease, treat these triggers seriously.
Symptoms can be subtle at first: trouble with sleep, mild forgetfulness, slower thinking, or personality changes. Look for signs that worry you: worsening confusion, trouble speaking, shakiness of the hands (called asterixis), clumsiness, or marked sleepiness. Caregivers often notice small changes before the person does—write them down and share with the medical team.
Treatment, prevention, and home care
Treatment aims to remove the trigger and lower toxin levels. Hospitals use fluids, antibiotics for infections, and blood transfusion if bleeding is present. Two main drugs lower ammonia: lactulose (a syrup that makes you pass ammonia in stool) and rifaximin (a gut antibiotic). Doctors often start lactulose first and add rifaximin if episodes repeat. Electrolytes like sodium and potassium are checked and corrected as needed.
At home, practical steps help prevent flare-ups. Keep bowel movements regular—lactulose works but so does fiber and simple routines. Avoid sedatives, sleeping pills, and alcohol. Keep hydrated and treat infections fast; even a bladder infection can trigger HE. Protein myths persist: don’t cut protein drastically unless your doctor advises it. Most people do better with normal protein sources, spread evenly across meals.
Caregivers should make the home safe: remove trip hazards, label medications, and keep a simple log of mental changes, bowel movements, and medications. If confusion gets worse, they sleep more than usual, or breathing becomes slow, go to emergency care. These are red flags that need urgent attention.
Follow-up matters. Regular liver clinic visits, vaccines (flu, pneumonia), and medicines adjusted by a liver specialist reduce risk. Your pharmacist can help with medicine schedules, check for drug interactions, and suggest practical tips to manage lactulose side effects like gas or cramps.
Hepatic encephalopathy can feel scary, but many episodes are treatable and preventable with quick action, clear routines, and good teamwork between you, caregivers, and your care team.
