What Are the Treatments for Liver Encephalopathy?

Liver encephalopathy, also referred to as hepatic encephalopathy, is a potentially reversible neuropsychiatric dysfunction that stems from disorders affecting the liver such as cirrhosis or hepatitis, or conditions in which blood does not circulate through the liver. The direct cause is not known. It is characterized by intellectual and speech impairment, personality change, dementia, confusion, tremors and sleepiness. Patients with this disorder are usually not able to care for themselves and may require frequent hospitalization. Treatment of both the acute and chronic forms of liver encephalopathy is available. Recovery as well as the chance of the condition recurring vary on an individual basis.

Diet

• Excessive protein intake may lead to an increase in the body's production of ammonia. When the liver is impaired and cannot properly filter the blood, protein consumption needs to be carefully balanced so that the patient receives proper nourishment, but excess ammonia does not lead to further brain dysfunction or kidney damage. Salt consumption is also restricted to prevent fluid accumulation in the abdomen. Alcohol is forbidden as it can cause further liver damage.

Lactulose

• Lactulose, a synthetic sugar compound that causes diarrhea, or other laxatives are provided to remove blood from the intestines and lessen the time available for protein to metabolize into ammonia. Dosage needs to be adjusted to prevent abdominal cramping, bloating, diarrhea and electrolyte imbalance. Optimal dosing leads to two to four loose stools per day. Lactulose may be prescribed rectally for patients who cannot tolerate oral medications.

Antibiotics

• Antibiotics such as neomycin are prescribed to kill bacteria present in the bowel and decrease the bacterial conversion of protein to ammonia in addition to other toxic substances. Rifaximin, a newer antibiotic with fewer side effects, has also been proven effective in the treatment of liver encephalopathy.

Digestive Tract Disorders

• Digestive tract disorders that lead to the onset (or recurrence) of liver encephalopathy must be treated. These include infections, electrolyte abnormalities, kidney failure, metabolic failure and constipation. Gastrointestinal bleeding needs to be stopped and the intestines emptied of any blood.

Sedatives

• Patients with liver encephalopathy who experience severe agitation may be prescribed haloperidol as a sedative. Any medications that are released or broken down by the liver as well as those that depress central nervous system function are discontinued. This includes benzodiazepines, frequently used to treat symptoms of alcohol withdrawal. Liver encephalopathy patients who are withdrawing from alcohol may remain on benzodiazepine treatment while receiving increased lactulose to address liver encephalopathy.