a woman with her head full of scribbles

Signs You Have Hepatic Encephalopathy

When we are having trouble thinking clearly with hepatitis C, it might be time to look for signs you have hepatic encephalopathy (HE), also known as brain fog. It’s very frightening because we can go in and out of it, depending on how much ammonia is in our blood stream, what we ate, or how well our meds are working. I had HE for many years and didn’t know it. Even after my diagnosis with hep C, my ammonia levels would be fine, and I could still be having an episode. Once you begin to notice the symptoms, it can be easier to detect, but many times we need help from medicine, our doctor, and a caregiver when we have HE.

What are the symptoms of hepatic encephalopathy?

    Slugglish mind

    At first, we appear to be taking a second to think about something. The truth is, thoughts slip away and we don’t even realize it. Forgetful - It’s easy to become scattered with our thoughts and we may have trouble remembering what we are doing or saying.


    This may apply to our thoughts, and certainly describes most of my life. I carried planners, day books, and had sticky notes all over my house, car, and at work. I appeared organized, but I was a hot mess.

    Personality changes

    This one is sad, because my daughter said that I became argumentative over silly things. It’s usually not my style, but with HE, I would take a stand over things that really didn’t matter. She learned to overlook it.


    It’s not like really in denial because we don’t remember saying or doing something.

    Poor judgement

    Silly things like putting the leftovers in the bathroom cabinet are fairly harmless. Trying to drive when we are too foggy to find our car keys is another.


    With hepatic encephalopathy, we can easily trust the wrong people. It’s important to surround ourselves with people who will tell is the truth in a loving and respectful way. They can warn us and protect us about from someone who may take advantage of us.


    We may have slight tremors when our brain gets too foggy.

    Slow movement

    This is one we have to be careful with. During an HE episode, we can become clumsy. Dizziness may even bring on an unstable gait.

    Drunk-like feeling

    I vaguely remember some events and conversations in my life. There were many times I was in a dreamlike, drunken state.


    It’s hard to keep your marbles when they’re rolling around everywhere. That’s how I felt many times. I wanted to get it all together and have things in order, but thoughts, actions, speech, and emotions seemed to swirl around. It's a scary time.

Talk to your doctor

In the long run, the signs you have hepatic encephalopathy are a lot like the signs of other health conditions, or even simple signs of aging. HE can be diagnosed by your doctor with blood tests (labs). These tests are fairly reliable, but my doctor saw signs of HE even when my ammonia levels were low. He prescribed Lactulose and Xifaxin, which are 2 powerful drugs to help lesson the effects of HE. They can prevent you from going into a hepatic coma.

If you have hepatitis C, liver disease, or cirrhosis in addition to the above signs, please let your doctor know right away. You’re not alone in the struggle, so please reach out for help.

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