Hepatic encephalopathy (HE) describes the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction. The wide range of neuropsychiatric presentations led to the expansion of consensus HE classification terminology by the World Congress of Gastroenterology in 2002.

Hepatic encephalopathy (HE) explains the spectrum of potentially reversible neuropsychiatric abnormalities seen in patients with liver dysfunction.

Identification and cancellation of such precipitating factors as electrolyte abnormalities, infection, medications, and gastrointestinal bleeding are crucial when handling acute HE.

Nonabsorbable disaccharides (lactulose and lactitol) are the first-line agents for the treatment of acute HE; these agents demonstrate symptom improvement in 67% to 87% of patients.

Antibiotics, including neomycin, metronidazole, and rifaximin, are used in patients who do not tolerate nonabsorbable disaccharides or patients who remain symptomatic on nonabsorbable disaccharides and require a second agent.

Early nutritional support with a regular protein diet will not worsen an acute HE episode.

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