How Do I Diagnose and Manage Acute Hepatic Encephalopathy?

  • Brent A. BeckerEmail author


Hepatic encephalopathy (HE) is a state of cerebral dysfunction due to accumulated ammonia and other toxins in patients with underlying liver insufficiency and/or portosystemic shunting. The diagnosis is largely clinical, but the differential is extensive. Broad diagnostic testing is necessary to exclude alternative etiologies. Asterixis is a classic finding, but is not pathognomonic. Serum ammonia concentrations do not correlate well with disease severity. Providers should strongly consider cerebral edema and intracranial hypertension. Lactulose and rifaximin comprise first-line treatment, but identification and correction of precipitating factors are essential.


Hepatic encephalopathy Cirrhosis Hyperammonemia Cerebral edema Lactulose Rifaximin 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.WellSpan York Hospital, Department of Emergency MedicineYorkUSA

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