Hepatic Encephalopathy

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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 precipitating factors, and removal or neutralization of ammonia and other toxins. Life support may be required, including support of breathing or circulation, particularly if coma develops. The brain may develop swelling, which can be life-threatening.

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

In patients with severe, repeated cases of encephalopathy, the patient may be advised to reduce protein in the diet to reduce 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.

Sedatives, tranquilizers, and any other medications that are metabolized or excreted 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.