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Hepatic encephalopathy

Encephalopathia hepatica · Jaterní encefalopatie

What it is

Confusion from a failing liver that no longer clears ammonia and other gut toxins; set off by bleeding, infection, constipation or sedatives.

Symptoms & signs

  • Confusion and sleepiness
  • day–night reversal
  • flapping tremor of the hands
  • personality change
  • coma

🚩 Get help if…

  • call 112 / 911 now Very drowsy, hard to wake or confused
  • call 112 / 911 now Vomiting blood or black stools with confusion
  • see a doctor soon Flapping hands, muddled speech or reversed sleep
  • see a doctor soon No stool for 2 days or a fever in someone with cirrhosis

Where it strikes

Medical treatment

  • Find and treat the trigger
  • lactulose
  • rifaximin
  • nutrition with enough protein
  • liver-transplant assessment

Natural & lifestyle

  • Regular bowels
  • no alcohol or sedatives
  • small frequent meals and a late-evening snack

Emerging & experimental

  • Faecal microbiota transplant
  • L-ornithine L-aspartate

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Probiotics — trials disagree mixed evidence
  • Branched-chain amino acids — a Cochrane review found fewer symptoms, no effect on survival trials support
  • Zinc — deficiency is common; small trials early / small studies

ICD codes