Hepatic encephalopathy occurs when the liver can not remove certain toxins and chemicals, such as
ammonia, from the
blood.1 These toxins and chemicals then build up and enter the brain.1 Hepatic encephalopathy is one of the major complications of cirrhosis (scarring of the liver), and a leading cause of hospital re-admission due to its recurrence, despite treatment.1 It can occur suddenly in people with acute liver failure, but is seen more often in those with chronic liver disease.1 Symptoms of hepatic encephalopathy include mild confusion, forgetfulness, poor
concentration and personality or mood changes, but can progress to extreme anxiety, seizures, severe confusion, jumbled and slurred speech and slow movement.1 The first step in treatment is to identify and treat any factors that cause hepatic encephalopathy.2 Once the episode has resolved, further treatment aims to reduce the production and absorption of toxins, such as
ammonia.1 Generally, there are two types of medication used to reduce the likelihood of another hepatic encephalopathy episode — lactulose and rifaximin.2 However, it remains a leading cause of hospitalisations and re-hospitalisations in cirrhotic patients, despite the use of the above - mentioned standard of care treatment.
Fresh whole
blood, fresh packed red
blood cells or fresh frozen plasma typically are used, because stored
blood products contain high
ammonia concentrations which are undesirable in most cases of liver disease.