a woman rubs her temple as we see her liver and brain covered in a fog

What is Hepatic Encephalopathy?

What is hepatic encephalopathy? For me, it’s one of the most cruel parts of advanced liver disease. In fact, a patient like me may not even know they are in a brain fog state. Basically, hepatic encephalopathy is when the liver causes a state of utter mental confusion. I’ll share the causes, symptoms, and treatments of hepatic encephalopathy.

My experience with hepatic encephalopathy actually began years before I knew about my liver disease, which is common. Because hep C was silently destroying my liver a little bit at a time, I also slowly lost my mind, a little bit at a time. In fact, it came on so slow, that no one even noticed. My symptoms could have been from a variety of causes. Who would have suspected cirrhosis from hep C was causing my mental distress?

Symptoms of hepatic encephalopathy

The symptoms of hepatic encephalopathy can include...

  • Memory Loss
  • Confusion
  • Silly
  • Argumentative
  • Sluggish
  • Irrational
  • Stupor
  • Immature
  • Hallucination
  • Blackout
  • Coma

The symptoms of hepatic encephalopathy don’t necessarily progress in any order. Like I said, mine came on slow, and out of the blue I began sleeping all the time. You may have had more, or less symptoms, in your battle against brain fog from liver disease.

Cause of hepatic encephalopathy

The cause of hepatic encephalopathy is considered to be from the liver not being able to process foods. The digestive process can create an ammonia overload. As ammonia builds up in the brain, a sleepy type stupor can come on so slowly, that a person does not even know it.

Testing and diagnosis

Many doctors still rely on testing the ammonia levels in the blood stream. Others will do a clinical evaluation. The clinical evaluation will be done in person by the medical provider. A patient may be timed while writing their name and current date. They may also be asked to do simple math problems.

More on this topic

You may have additional testing at a specialist’s office. A hepatologist will look at general health and blood labs too. If there is ascites swelling, vomiting blood, or extreme weight loss, those are big indications that a patient is living with hepatic encephalopathy.

Treatment options

For now, most doctors will agree that rifaximin and lactulose are the first line of treatment. The side effects of drinking a dose of liquid lactulose include soft stool and cramping. Rifaxamin is a pill, and has fewer or no side effects. These 2 prescriptions are the main medications used for brain fog that is caused by hepatic encephalopathy.

In addition, good nutrition has been shown to help reduce brain fog that is caused by hepatic encephalopathy. Getting healthy protein, and keeping strong muscles also helps to metabolize ammonia in our body. After being diagnosed with hep C, I started on lactulose and Xifaxin. By taking my medication on time, the brain fog improved quickly. Finally, everything began to make sense to me again. My diet improved as I made better choices.

There is hope for hepatic encephalopathy

Even though my liver was in bad shape, and the brain fog was very severe, I trusted my doctor and slowly got better. Soon, I was able to start treatment, and get rid of the hep C virus. After that, my brain began to clear up. Thankfully, hepatic encephalopathy is reversible. Once I had no viral load, I got my mind back, and the effects on my liver slowly started to reverse.

Which of the above symptoms of hepatic encephalopathy have you experienced?

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