Hepatic encephalopathy history and symptoms

In patients with hepatic encephalopathy, symptoms may have an insidious onset and progression, or may begin suddenly and progress rapidly. The hallmark of hepatic encephalopathy is hyperammonemia. A positive history of hepatic failure is suggestive of hepatic encephalopathy. The most common symptoms of hepatic encephalopathy include inverted sleep-wake pattern (combination of restless nights and excessive daytime sleepiness), personality changes, altered level of consciousness, bilateral flapping hand tremors on arm extension (asterixis), confusion and irritability.

In patients with hepatic encephalopathy, symptoms may have an insidious onset and progression, or may begin suddenly and progress rapidly. The hallmark of hepatic encephalopathy is hyperammonemia leading to altered mental status.^[1] A positive history of hepatic failure is suggestive of hepatic encephalopathy. The most common symptoms of hepatic encephalopathy include inverted sleep-wake pattern (combination of restless nights and excessive daytime sleepiness)^[2], personality changes^[3], altered level of consciousness^[4], bilateral flapping hand tremors on arm extension (asterixis)^[5], confusion and irritability.^[6]

Patients with hepatic encephalopathy may have a positive history of:^{[7][8][3][6][9][10][11]}

• Hepatic cirrhosis
• Hepatic failure
• Gastrointestinal bleeding
• Portacaval shunt

• Epilepsy
• Diabetes mellitus
• Hyponatraemia
• Renal failure
• Hyperblilirubinemia
• Hypokalemia
• Sepsis

Common symptoms of hepatic encephalopathy include:

• Personality changes
• Altered level of consciousness
• Bilateral flapping hand tremors on arm extension (asterixis)
• Confusion
• Irritability
• Inverted sleep-wake pattern (combination of restless nights and excessive daytime sleepiness)