Hepatic encephalopathy

Patients with profound altered mental status, obtundation, and concern for inability to protect the airway should be monitored in the intensive care unit. All patients with cirrhosis and an episode of HE should be referred to a gastroenterologist. Outpatients should be monitored every 3 months. A neurologist should be consulted in an acute episode of HE if a nonmetabolic cause of altered mental status is suspected or if there is an abnormality on neuroimaging.