Health Resources

Define an Episode of Hepatic Encephalopathy

Once you have identified and treated patients with hepatic encephalopathy (HE), work with them and/or their caregivers to come up with a management plan to help reduce the risk of recurrence by monitoring for symptoms and identifying an episode of overt HE (OHE). If patients are monitored regularly, symptoms of an OHE episode can be addressed before a transition of care is needed.

A potential episode or occurrence in patients with OHE can be identified by testing/monitoring for the following symptoms1:

  • Disorientation for time. Getting any 3 of the following wrong: day of the month, day of the week, month, season, or year
  • Lethargy or apathy
  • Obvious personality change
  • Inappropriate behavior
  • Dyspraxia
  • Asterixis
  • Somnolence to semistupor
  • Responsive to stimuli
  • Confusion
  • Gross disorientation
  • Bizarre behavior
  • Coma
Patients with a previous occurrence of OHE have a 40% risk of recurring OHE at 1 year.1
Patients with recurrent OHE have a
40% risk of another recurring within 6 months, despite lactulose treatment.1
In 2018, 37% of hospitalized patients with OHE were readmitted within 30 days.2

The LIVERHEALTHNOW resources in this section have been developed to help you recognize evidence of HE episodes so you can help reduce the risk of recurrence and even HE-related hospitalization. There are also resources to help patients and/or their caregivers monitor symptoms between medical visits.

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Provider Resources

  • Monitoring and Documenting Overt Hepatic Encephalopathy Episodes
  • Help Patients Set Goals Using Shared Decision Making
  • Counseling Your Hepatic Encephalopathy Patients About Driving
  • Coding of Hepatic Encephalopathy

Patient Resources

  • Important Signs and Symptoms for Patients With Chronic Liver Disease
  • Prevent Another Attack for Overt Hepatic Encephalopathy
  • Importance of Taking Medication as Prescribed for Overt Hepatic Encephalopathy
  • Goal Setting When You Have Chronic Liver Disease
  • Living With Diabetes and Liver Disease
  • Setting Up Medical Alerts on Digital Devices
  1. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715-735.
  2. Data on file. Forte 2020. Salix Pharmaceuticals, Bridgewater, NJ.