[Hepatic coma]

The term "hepatic encephalopathy" describes the neuropsychiatric signs and symptoms of patients with acute or chronic liver disease, irrespective of the presence or absence of liver cirrhosis. Cerebral edema, the pathophysiology and treatment of which being quite different from hepatic encephalopathy, is the leading cause of death in patients with acute liver failure. Lactulose (orally or as enema) is one of the cornerstones of the treatment of hepatic encephalopathy; most important for the management of patients with cerebral edema is close monitoring (including intracranial pressure monitoring) of the patients and rapid reduction of intracranial pressure (e.g. with mannitol). The pathophysiologic and therapeutic concepts in the care of patients with hepatic encephalopathy and cerebral edema are described.