Tuesday, March 12, 2019

Hepatic Encephalopathy

emDocs - March 11, 2019 - Authors: Mohammadie S and Zeidan A 
Edited by: Koyfman A and Long B
  1. HE is common in patients with cirrhosis and is the most common reason for readmission. Patients with cirrhosis who experience HE have an increase in mortality demonstrating the seriousness of this common disease.
  2. Clinicians should rely on the history, exam, and clinical suspicion when diagnosing HE, rather than ammonia levels.
  3. Causes of HE are typically due to increased generation of ammonia or decreased clearance. The most common precipitants include infection, GI bleed, dehydration, AKI, lactulose nonadherence, and constipation.
  4. Patients with cirrhosis are more susceptible to developing infections due to a dysfunction of host defense mechanisms as well as dysregulation of inflammatory cytokines.
  5. Diet and hydration status are critical in patients with cirrhosis. Dehydration is a common precipitant of HE due to use of diuretics, lactulose, large volume paracentesis, poor PO intake, and difficult medication titration post TIPS.
  6. Less common precipitants to keep in mind when evaluating for HE include concomitant precipitants, such as infection and
  7. Be wary of new medications in cirrhotic patients. Consider reviewing side effects of all medications used in patients with cirrhosis before prescribing to assess for hepatotoxicity:"