Triggers for hepatic encephalopathy

Various factors can trigger HE. Such factors may include:

  • Infections1
  • Bleeding from the digestive tract1
  • Constipation1
  • Dehydration1
  • Disturbances in the body’s electrolyte balance (e.g. potassium and sodium levels) 1

Medications such as sleeping tablets (sedative drugs) and water pills (diuretics) can also increase the risk of HE. Dietary factors such as excessive protein intake can trigger episodes of HE. 1 Predisposing conditions like sarcopenia3 and epilepsy4 can increase a person’s risk of developing HE.

The first signs and symptoms of hepatic encephalopathy

Hepatic encephalopathy presents in various ways, 1 but some symptoms include:

  • Personality change1
  • Confusion and disorientation1
  • Tremor and difficulty with voluntary movements1
  • Disturbed sleep-wake cycle1

HE can develop without any apparent signs or symptoms.2 When signs and symptoms do present they can be mental or physical. 1 Healthcare teams use certain clinical scales to assess the severity of HE. The West Haven Criteria is currently the gold standard of diagnosis and uses 4 grades to determine the severity.1

Symptoms of HE may be noticed by patient relatives.1 Ask your friends and family to look out for these symptoms. If you suspect you may have symptoms of HE you should seek advice from your healthcare team as soon as you can, as earlier detection reduces the progression to worse stages of HE.5

Frau schaut aus dem Fenster und denkt über Auslöser einer hepatischen Enzephalopathie nach

Earlier detection reduces the progression to worse stages of HE


  1. Ferenci P, Gastroenterology Report. 2017;5(2):138–147
  2. National Organization for Rare Disorders, Hepatic Encephalopathy. Available at: [Last accessed: November 2020]
  3. Jindal A, R Jagdish, Clinical and Molecular Hepatology. 2019;25:270-279
  4. Jepsen P et al., BMC Gastroenterology. 2016; 16(1)
  5. Parker R, British Journal of Nursing. 2020;29(17)

May 2021. GL-HEP-XIF-2000177