Encephalopathy from cirrhosis

When the liver has been damaged by cirrhosis, it may not be able to filter poisons from the bloodstream, especially substances in the blood produced by bacteria in the large intestine. As a result, these substances (which include ammonia) may build up in the bloodstream and cause problems in your brain called encephalopathy. High ammonia levels are a sign of encephalopathy.

Symptoms of encephalopathy may include:

  • Irritability.
  • Depression.
  • Drowsiness.
  • Difficulty with word-finding.
  • Poor short-term memory.
  • Poor concentration.
  • Confusion and disorientation.
  • Insomnia.
  • Coma.

Encephalopathy is most likely to occur in people who have high blood pressure in the portal vein system (portal hypertension). But it may also occur in people who have severe acute liver damage but do not have portal hypertension. Certain procedures (such as shunting, which redirects the flow of blood or fluid through other areas of the body) that help lower portal hypertension and prevent variceal bleeding may actually increase your risk for developing encephalopathy. Other factors that can contribute to encephalopathy include use of sedatives or narcotics, gastrointestinal bleeding, abnormal levels of electrolytes in the blood (especially low potassium levels), excess protein in the diet, infection such as peritonitis, dehydration, and constipation.

Most cases of encephalopathy are treated using a medicine called lactulose. This drug helps prevent the buildup of substances in the large intestine that may lead to encephalopathy. Lactulose is effective at decreasing ammonia levels in the blood. And it has been shown to improve encephalopathy in 80% of the people who receive appropriate doses of it.1

Side effects of lactulose may include:

  • Stomach cramps.
  • Diarrhea.
  • Intestinal gas.
  • Itching.

There is some evidence that an artificial sweetener called lactitol may be as effective as lactulose but may cause fewer side effects and may taste better than lactulose.1 Lactitol is not yet approved for use in the United States.

Citations

  1. Fitz JG (2006). Hepatic encephalopathy, hepatopulmonary syndromes, hepatorenal syndrome, and other complications of liver disease. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 2, pp. 1965–1991. Philadelphia: W.B. Saunders.

Last Updated: January 22, 2010

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