Answers
What is hepatic encephalopathy (confusion in liver disease)?
Short answer
Hepatic encephalopathy is a change in brain function caused by liver disease, most often cirrhosis. When the liver cannot clear toxins from the gut, they affect the brain, causing forgetfulness, sleepiness, confusion and, in severe cases, coma. It is usually brought on by a trigger and improves with treatment.
Early signs families notice
- Sleeping during the day and staying awake at night
- Forgetfulness, slow replies or poor concentration
- Changes in mood or behaviour
- Shaky, flapping hands, or changes in handwriting
- Later: confusion, drowsiness and difficulty waking
Common triggers
- Constipation
- Infections, including in the urine, chest or belly fluid
- Bleeding in the stomach or food pipe, with black stools
- Dehydration, vomiting, loose motions or too many water tablets
- Sleeping pills and sedatives
- Alcohol
Treatment
Protein should not be cut down. People with cirrhosis need enough protein, from dal, curd, paneer, eggs, fish or chicken, spread across the day, with a small bedtime snack.
- Finding and treating the trigger
- Lactulose syrup, adjusted so that the person passes two to three soft stools a day
- Sometimes an antibiotic that acts in the gut (rifaximin) to prevent repeat episodes
- Hospital care for confusion or drowsiness
When it is an emergency
Take the person to hospital straight away, or call 112, if they become very drowsy, cannot be woken easily, are very confused, or have black stools or vomit blood. People who have had hepatic encephalopathy should not drive until their doctor says it is safe.
Diet in hepatic encephalopathy
Eat more
- Enough protein through the day, especially from dal, curd, milk, paneer, eggs and fish
- Small meals every 2 to 3 hours and a bedtime snack
- Fibre from vegetables, fruits and whole grains to keep stools soft
Cut down
- Long gaps without food or fasting
- Alcohol, completely
- Salt, if there is also fluid in the belly
Good to know
- Cutting protein is an old idea. It weakens muscles, and weaker muscles make confusion more likely.
- Constipation is a common trigger, so make sure there are two to three soft stools a day.
Common questions
Can hepatic encephalopathy come back?
Yes, especially if a trigger such as constipation, infection or bleeding occurs. Regular medicines and early treatment of triggers prevent most repeat episodes.
Is the confusion permanent?
Usually not. It often clears completely once the trigger is treated. Repeated episodes are a sign that liver transplant should be discussed.
What should the family watch for at home?
Day-time sleepiness, a change in behaviour or handwriting, constipation, fever and black stools. If you notice these, contact the doctor the same day.