A life-threatening sign your liver is struggling – Hepatic Encephalopathy

Hepatic Encephalopathy (HE) is the decline in brain function in people with advanced liver diseases. The liver filters our blood, breaks down toxins into waste products, and excretes them. When our liver doesn’t function properly, toxins build up in the bloodstream, reach the brain and affect brain function. It may impact one’s mood, speech, and the way they act & feel, and in worst cases, one may slip into a coma. But, with proper diagnosis and liver damage treatment, the condition is reversible and curable.

What are the causes of Hepatic Encephalopathy?

According to recent research, up to 50% of people who suffer from Cirrhosis (of the liver) develop Hepatic Encephalopathy.

A damaged liver cannot filter natural toxins like ammonia from our bloodstream. And high ammonia levels can damage the brain, nerves & other organs, cause coma and even death. HE may also be triggered by:

  • Medications such as benzodiazepines, barbiturates, and sleeping pills
  • Kidney diseases that lessen the amount of urine and waste excretion from the body
  • Electrolyte imbalance caused by diarrhoea, vomiting or dehydration
  • Bleeding from the digestive tract (intestines, oesophagus and stomach)
  • Consumption of a high protein diet
  • Recent surgery
  • Alcohol binge
  • Constipation, and
  • Liver shunt

What are the symptoms of Hepatic Encephalopathy?

While people with HE experience impaired brain function, the symptoms and severity vary depending on whether the condition is acute or chronic. The symptoms might start slow, occur episodically, worsen, and then improve only to recur. Under severe conditions, one may require immediate hospitalisation.

People with Hepatic Encephalopathy may experience

  • cognitive impairment (problems with learning, thinking, remembering or making decisions)
  • slow or confused speech that is difficult to comprehend
  • uncontrollable twitching of muscles
  • severe anxiety or irritability
  • changes in sleep pattern
  • shaky or flappy hands
  • forgetfulness, and
  • seizures

According to NCBI, patients with minimal hepatic encephalopathy have poor eyesight, impairing their ability to drive vehicles. Hence a person must seek medical help should they notice one or more of the symptoms.


Though office examination and discussion of the person’s symptoms & medical history may help ascertain HE in some cases, a gastroenterologist may prescribe additional tests. They include blood tests, CT scans, MRI, and Liver Function Tests.


Treatment for Hepatic Encephalopathy depends on several factors, including the severity of liver damage, the severity of symptoms, the underlying cause, and the patient’s age & health.

If a high-protein diet is what triggers your HE, your doctor may suggest a diet plan that provides the right amount of protein without making the symptoms worse. If it’s due to internal bleeding, kidney problems, or urinary infections, they might prescribe medications. Other popular treatment methods include

Lactulose Oral Treatment: Lactulose is a synthetic sugar that speeds up digestion and gets rid of excess ammonia from your body by stimulating frequent bowel movements.

Antibiotics: They curb bacteria that create toxins during the digestion process.

If nothing works out, a person may need a liver transplant surgery Hepatic Encephalopathy is a curable condition if diagnosed early and treated. Should you suffer from liver disease, being informed about the triggers and warning signs of HE will go a long way.

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