Hepatic encephalopathy may become a medical emergency. Hospitalization is required.
The first step is to identify and treat any factors that may have caused hepatic encephalopathy.
Gastrointestinal bleeding must be stopped. The intestines must be emptied of blood. Infections, kidney failure, and electrolyte abnormalities (especially potassium) need to be treated.
Life support may be necessary to help with breathing or blood circulation, particularly if the person is in a coma. The brain may swell, which can be life-threatening.
Patients with severe, repeated cases of encephalopathy may be told to reduce protein in the diet to lower ammonia production. However, dietary counseling is important, because too little protein in the diet may cause malnutrition. Critically ill patients may need specially formulated intravenous or tube feedings.
Lactulose may be given to prevent intestinal bacteria from creating ammonia, and as a laxative to remove blood from the intestines. Neomycin may also be used to reduce ammonia production by intestinal bacteria. Rifaximin, a new antibiotic, is also effective in hepatic encephalopathy.
Sedatives, tranquilizers, and any other medications that are broken down by the liver should be avoided if possible. Medications containing ammonium (including certain antacids) should also be avoided. Other medications and treatments may be recommended. They may have varying results.