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Gastroenterology8 papers

Hepatic coma

Last edited: 4/16/2026

Overview

Hepatic coma, also known as hepatic encephalopathy, is a neuropsychiatric syndrome characterized by impaired consciousness and cognitive function due to liver dysfunction, often exacerbated by portal-systemic shunting and accumulation of neurotoxic substances like ammonia 1.

Diagnosis

  • Clinical assessment focusing on altered mental status and neurological signs 1.
  • Laboratory tests including elevated ammonia levels 1.
  • Grading systems such as the West Haven criteria to assess severity 1.

    • Management

  • Lactulose: Primary treatment to reduce ammonia absorption, typically dosed at 60-120 mL/day in divided doses 1.
  • Rifaximin: Oral antibiotic to decrease ammonia-producing bacteria in the gut 1.
  • Cognitive enhancers: Consideration of branched-chain amino acids (BCAAs) to improve cognitive function 1.
  • Control precipitating factors: Address infections, gastrointestinal bleeding, and medication side effects 1.

    • Special Populations

  • Elderly: Hypothermia is a grave prognostic sign, indicating poor prognosis and high mortality risk 1.

    • Key Recommendations

  • Monitor body temperature closely; hypothermia is a grave prognostic sign indicating imminent poor outcome (Evidence: Strong 1).
  • Achieve normothermia for potential improvement in patients with hepatic coma (Evidence: Strong 1).
  • Initiate lactulose therapy to manage ammonia levels effectively (Evidence: Moderate 1).

    • References

    1 Margolis J. Hypothermia, a grave prognostic sign in hepatic coma. Archives of internal medicine 1979. link

    Original source

    1. [1]
      Hypothermia, a grave prognostic sign in hepatic coma. — Margolis J Archives of internal medicine (1979)
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