Hepatic encephalopathy management: literature review

Augustaityte Agne 1, Petrauskaite Ieva 1

1 Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania 



Hepatic encephalopathy (HE) is one of the most common complications of severe acute or chronic hepatic diseases. The main pathogenetic mechanism is the entrance of neurotoxic substances into the systemic circulation and their passage through the blood-brain barrier due to hepatic insufficiency which results in inability to perform detoxification. This leads to the development of neurological symptoms such as mood instability, sleep disturbance, and even coma. The stage of HE is determined by the severity of the predominant symptoms, and is usually based on West-Haven criteria. The management of HE is combined and is aimed at liver function improvement, elimination or adjustment of causes of HE and reduction of neurotoxic substances production. Therefore, both conservative and invasive treatment methods are used. When inhibiting the formation of ammonia in the intestine, it is very important to pay attention to the patient’s diet, especially to the amount of protein in it. If necessary, the patient is given additional substances (vitamins, fluids). One of the most commonly used drugs for the treatment of HE is lactulose, the effectiveness of which has been proven by research. This non-absorbable disaccharide helps to remove nitrogen-containing compounds from the body by causing diarrhea, as well as lowering the intestinal pH and preventing the absorption of glutamine. The production of enteric toxins is significantly reduced by antibiotics. The most commonly used antibiotic is rifaximin, which has the least side effects and is suitable for long-term treatment. L-ornithine-L-aspartate promotes the synthesis of urea and glutamine and the elimination of ammonia from the body. Administration of zinc significantly reduces hyperammonemia as zinc reduces urea synthesis by acting as a cofactor. MARS or transjugular shunt embolization are interventional methods that are commonly used as adjuncts prior to liver transplantation.

Keywords: Hepatic encephalopathy, hepatic encephalopathy treatment, minimal hepatic encephalopathy.