Understanding hepatic encephalopathy symptoms and stages

What are the signs of hepatic encephalopathy?

Hepatic encephalopathy starts slowly. People with hepatic encephalopathy may not even know they have it. To them, things seem fine. But things may not seem fine to family or friends.

People with worsening hepatic encephalopathy may not be able to drive a car or work a steady job. They may also need to rely on a caregiver to take care of them. In serious cases, hospitalization, coma, and even death can occur.

Knowing the signs of hepatic encephalopathy can help slow it down before it gets worse. Let a doctor know right away if you or a loved one is beginning to show these signs or has shown them before. That way you can get treatment for your hepatic encephalopathy.

Mental signs:

  • Forgetfulness, mild confusion
  • Poor judgment
  • Being extra nervous or excited
  • Not knowing where they are or where they're going
  • Inappropriate behavior or severe personality changes

Physical signs:

  • Breath with a musty or sweet odor
  • Change in sleep patterns (often awake at night and sleeping during the day)
  • Worsening of handwriting or loss of other small hand movements
  • Movements or shaking of hands or arms
  • Slurred speech
  • Slowed or sluggish movement

What are the stages of hepatic encephalopathy?

  • Stage 1

    Mild hepatic encephalopathy

    Patients may have sleep problems and trouble concentrating. They may have severe mood swings. Their hands might shake and they may have difficulty writing.

  • Stage 2

    Moderate hepatic encephalopathy

    Patients may not have much energy. They keep forgetting things and have problems with basic math. They may behave strangely and slur their speech.

  • Stage 3

    Severe hepatic encephalopathy

    Patients are very sleepy and sometimes pass out. They can't do basic math at all. They act strange and can be very fearful and jumpy.

  • Stage 4

    Final stage

    The final stage of hepatic encephalopathy is coma—the patient is unconscious.

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