HARD DECISIONS IN INTENSIVE CARE UNIT

Intensivecareunitkapak

HEPATIC ENCEPHALOPATHY

Hasan Oktay Emir

Ömer Halisdemi̇r University Training and Research Hospital, Department of Intensive Care, Niğde, Türkiye

Emir HO. Hepatic Encephalopathy. In: Turan S, editor. Hard Decisions in Intensive Care Unit. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.139-149.

ABSTRACT

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that develops in the presence of liver failure and/or portosystemic shunt. It can be seen in a wide clinical spectrum ranging from mild cogni- tive impairment to coma. HE is a severe complication of cirrhosis and acute liver failure, significantly contributing to increased hospital admissions and mortality rates. In its pathophysiology, neurotrans- mission changes and neuroinflammation in the brain are caused by the effect of neurotoxic substances, especially ammonia.

Clinically, it is characterised by cognitive and motor impairments. Diagnosis is based on clinical eval- uation, laboratory tests and imaging modalities. Metabolic encephalopathies, toxic exposures and neu- rological diseases should be considered in the differential diagnosis.

Treatment focuses on eliminating trigger factors, lowering ammonia levels and adjunctive treatment. Treatments such as rifaximin and lactulose reduce intestinal ammonia production, while branched- chain amino acids and L-ornithine L-aspartate may provide additional support. In severe cases, inten- sive care support and liver transplantation may be necessary.

HE is a condition that diminishes patients’ quality of life and places a substantial strain on the health- care system due to its recurrent episodes. Therefore, early diagnosis and effective management are critical to improve the prognosis of patients.

Keywords: Hepatic encephalopathy; Intensive care

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