Hepatic encephalopathy

Hepatic encephalopathy (HE) is a serious and potentially life-threatening condition that occurs when the liver can no longer remove toxins from the blood, especially ammonia produced in the intestines. When these toxins build up, they impair brain function. Without prompt treatment, HE can progress to coma or death. HE most often develops in people with advanced liver disease, particularly cirrhosis, but it can also occur with acute liver failure, liver cancer, or after certain liver procedures. It affects 30–40% of people with cirrhosis. Alcohol use, infections, medications, internal bleeding, and blood flow abnormalities can trigger episodes. ⚠️ HE is a medical emergency. Sudden confusion, extreme sleepiness, or unresponsiveness requires immediate emergency care. Types of Hepatic Encephalopathy Type A: Caused by acute liver failure, developing rapidly over days or weeks Type B: Caused by abnormal blood flow (portosystemic shunts) that bypasses the liver Type C: Occurs in people with cirrhosis or acute-on-chronic liver failure HE may be: Overt: Symptoms are clearly noticeable Covert: Subtle cognitive changes detectable only with testing Symptoms Difficulty concentrating or confusion Disorientation (not knowing where you are) Daytime sleepiness or insomnia Memory problems Flapping hand tremor (asterixis) Personality or mood changes Slurred speech or poor coordination Coma in severe cases These symptoms can significantly reduce quality of life and daily functioning. Causes and Triggers Liver failure or cirrhosis Alcohol use Infections Gastrointestinal bleeding Electrolyte imbalances (low sodium or potassium) Dehydration or constipation Certain medications (sedatives, opioids, diuretics) Complications after liver transplant Risk Factors Advanced liver disease Diabetes or kidney disease Older age Low muscle mass (sarcopenia) High blood ammonia levels Alcohol use Poor nutrition Possible Complications Falls and injuries Long-term memory and attention problems Driving impairment Frequent hospitalizations Coma Death Prevention You can lower the risk of HE by: Taking medications exactly as prescribed Eating plant-based and dairy protein instead of excessive animal protein Avoiding alcohol, sedatives, and opioids Staying well hydrated Preventing constipation Treating infections promptly Attending regular liver checkups Early recognition and treatment of hepatic encephalopathy can be lifesaving. If you or someone with liver disease develops sudden mental changes, seek emergency medical care immediately.