[Management of hepatic encephalopathy]

Area of Science:

• Hepatology
• Critical Care Medicine
• Neurology

Context:

• Hepatic encephalopathy (HE) management requires a multifaceted approach.
• Current therapeutic strategies address critical patient care and specific complications.
• Understanding underlying pathophysiological mechanisms is crucial for effective treatment.

Purpose:

• To provide a comprehensive overview of current therapeutic principles for hepatic encephalopathy.
• To discuss various treatment modalities, from supportive care to advanced interventions.
• To highlight emerging and established treatment options for HE.

Summary:

• Key therapeutic principles include intensive patient care, maintaining fluid and electrolyte balance, and managing coagulation defects.
• Treatment strategies address gastrointestinal bleeding, portal hypertension, infection prophylaxis, and intracranial pressure monitoring.
• The study reviews toxic and neurotransmitter-based hypotheses, brain edema therapy, and extracorporeal therapies like hemodialysis, hemoperfusion, and plasmapheresis.
• It also covers glucagon-insulin therapy and emphasizes the critical role of liver transplantation in managing hepatic encephalopathy.

Impact:

• Provides clinicians with a consolidated guide to hepatic encephalopathy treatment protocols.
• Informs therapeutic decision-making by detailing a wide range of management options.
• Underscores the importance of a holistic approach, integrating critical care with specific etiological treatments and advanced therapies.