[Confusion and abnormal liver enzyme levels: problems with diagnosing hepatic encephalopathy]

Area of Science:

• Hepatology
• Neurology
• Internal Medicine

Background:

• Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome associated with liver dysfunction.
• It presents with a spectrum of neurological and psychiatric symptoms, often reversible with appropriate management.
• The exact pathophysiology is not fully elucidated, but ammonia toxicity is considered a key factor.

Observation:

• This case series describes three patients with liver failure who developed hepatic encephalopathy.
• Two patients with chronic liver disease experienced confusion and improved with lactulose treatment.
• A third patient with acute autoimmune hepatitis and liver failure progressed to coma and unfortunately succumbed.

Findings:

• Hepatic encephalopathy can be challenging to diagnose, particularly in its early stages, presenting as subtle cognitive impairment or distinct neurological episodes.
• While ammonia levels and EEG findings can support the diagnosis, HE is primarily a clinical diagnosis.
• Underlying conditions like infection or gastrointestinal bleeding frequently precipitate HE episodes.

Implications:

• Early recognition and prompt treatment of hepatic encephalopathy and its underlying causes are vital for reducing patient morbidity and mortality.
• Lactulose therapy demonstrated efficacy in managing HE in patients with chronic liver disease.
• The case highlights the critical need for timely intervention in acute liver failure to prevent fatal outcomes.