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Hepatic Encephalopathy

Walter M. Kim, PhD, MD and Sloan F Miler, M.D. Reviewed 04/2024
 

 

BASICS

DESCRIPTION

  • Reversible altered mental and neuromotor functioning in association with acute or chronic liver disease and/or portosystemic shunting

  • Wide spectrum of neurological/psychiatric abnorma...

DIAGNOSIS

HISTORY

Preexisting liver disease. Altered mental status, confusion. Impaired arousability. Constipation 

PHYSICAL EXAM

  • Age <10 years

    • Signs of underlying liver disease are prominent; fulminan...

TREATMENT

GENERAL MEASURES

  • Identify and treat precipitating causes: electrolyte imbalance, GI bleeding, infection

  • Avoid sedatives, benzodiazepines, opiates, diphenoxylate, and atropine

  • Grade I or higher...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Activity as tolerated once resolved. After the first HE episode, start secondary prophylaxis with nonabsorbable disaccharides (lactulose or lactitol) at 20 mL of ...

REFERENCES

1
European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatic encephalopathy. J Hepatol. 2022;77(3):807-824.
2
Shalimar, Sheikh MF, Mookerje...

ADDITIONAL READING

Acharya C, Bajaj JS. Current Management of Hepatic Encephalopathy. Am J Gastroenterol. 2018;113(11):1600-1612.  

SEE ALSO

Algorithm: Delirium 

CODES

ICD10

  • K72.91 Hepatic failure, unspecified with coma

  • K72.11 Chronic hepatic failure with coma

  • K70.40 Alcoholic hepatic failure without coma

  • K72.90 Hepatic failure, unspecified without coma

  • K72.9 Hepat...

CLINICAL PEARLS

  • HE includes a spectrum of neuropsychiatric findings that occur in patients with significant alterations in hepatic function

  • Lactulose is the cornerstone of therapy for HE

  • Asterixis (“liv...

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