Complications
Patients may be unable to protect their airway, possibly due to altered mental status.
Head of the bed should be maintained at 30° to help prevent aspiration and protect the airway. Intubation should be performed if needed.
Inflammation may be due either to chemical pneumonitis or to bacterial infection (typically anaerobic).
Antibiotic therapy should be directed at anaerobes (particularly in patients with poor dentition).
Overt HE is strongly associated with re-admission to the hospital within 30 and 90 days.[60]
HE increases the risk of falls. In a study of patients with cirrhosis who attended the accident and emergency department after a fall, HE was associated with severe injury (including intracranial haemorrhage, skull fracture, and pelvic fracture).[59]
Some patients have long-term persistent and non-reversible neurological deficits, including increased muscle tone, dysarthria or apraxia, dementia, parkinsonism, or myelopathy. Loss of employment or driving and inability to perform self-care are also complications, particularly if episodes recur.
Persistent impairment of working memory, response inhibition, and learning occurs after an episode of overt HE, even after alertness and orientation return to normal.[57] The number of hospitalisations for overt HE correlates with the severity of residual impairment.[56] Patients with recent overt HE on treatment have impaired performance in driving simulations and increased fatigue while driving.[58]
Unlike in acute liver failure, where cerebral oedema is common, in HE without acute liver failure this is an extremely rare complication.[61]
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