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Published on: August 8, 2025
Practical Issues in the Management of Overt Hepatic Encephalopathy
Ganesh Pantham1, Kevin D Mullen1
1Dr Pantham is a clinical instructor of medicine at Case Western University in Cleveland, Ohio, and a hospitalist in the Department of Medicine at the University Hospitals Cleveland Medical Center in Cleveland, Ohio. Dr Mullen is the section chief of digestive diseases and a professor of medicine at the West Virginia University School of Medicine in Morgantown, West Virginia.
Abstract:
Hepatic encephalopathy (HE) is a condition that encompasses a range of neuropsychiatric abnormalities in patients with significant liver disease. Overt HE occurs in approximately 30% to 45% of patients with cirrhosis. This article discusses practical issues in the management of patients with overt HE and cirrhosis, including a recently developed 4-pronged approach that consists of identifying and correcting precipitating factors, recognizing and treating concomitant medical conditions, commencing empiric treatment, and caring for the unconscious patient. Following recovery from overt HE, a plan of action should be developed to prevent readmissions.
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