Hepatic encephalopathy in the emergency department

Abstract

Objective: To analyze hepatic encephalopathy (HE) in the emergency department. Bibliographic review: HE is defined as the symptomatic loss of normal brain function caused by liver failure and/or portosystemic shunt, manifesting as a wide spectrum of neurological or psychiatric abnormalities, ranging from subclinical changes to coma. HE can be caused by low levels of oxygen in the body, use of medications such as benzodiazepines, antidepressants, and antipsychotics, as well as decreased bowel movements, gastrointestinal bleeding, excessive alcohol consumption, sepsis, and kidney irregularities. Gastrointestinal bleeding is the most frequent trigger associated with HE, probably because this condition is more common in patients with cirrhosis than in the general population. Final considerations: HE is one of the main and most serious complications of liver cirrhosis in the emergency department. In this context, prompt recognition of this condition is essential. Its treatment is primarily through supportive care and stabilization; the identification of precipitating factors; adequate nutritional support with a protein intake of 1.2 to 1.5 g/kg/day, in addition to medications such as lactulose, lactilol and rifaximin.