Hepatic encephalopathy laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

The normal plasma level of ammonia is 12 – 48 μmol/L.^[1] A study in 2019 found that elevated plasma ammonia (≥79.5 µmol/L) predicted HE grade 3 or more^[2].

The ammonia level can help diagnose encephalopathy^[3][4][5] although its ability is less clear in chronic liver disease^[6].

Ammonia levels over 123 are likely to improve with lactulose therapy.^[7]

An ammonia level more than 200 strongly suggests hepatic encephalopathy.^[3]

Other important laboratory findings in hepatic encephalopathy may include:

• Hyponatremia^[8]
• Hypokalemia^[9]

• Anemia is a predictor of hepatic encephalopathy in some patients with hepatic cirrhosis.^[10]
• Liver function tests: patients may have abnormal bilirubin, albumin, AST, ALT, AST/ALT, INR due to underlying hepatic disease.^[11]
• Hypercreatinemia may be present in patients with end-stage liver disease.^[12]

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