Patient discussions
Patients with cirrhosis should be advised to avoid factors that precipitate the development of HE, such as sedative use, constipation, and hypoglycemic or hypoxic states. They should also be advised to seek medical attention if they have any gastrointestinal bleeding, develop an infection, or feel ill. Research has shown that patients with a history of HE and their caregivers tend to have limited disease awareness. One pilot study demonstrated that a single, quick (15-minute) educational intervention was effective in reducing readmission rates and increasing awareness of the basic pathophysiology of HE, common treatments, and how to ensure/maintain regular bowel emptying.[60]
Patients should be instructed to avoid opioids, alcohol, and benzodiazepines.
Patients should be advised regarding their country's national driving regulations for those with previous episodes of HE. Expert consensus recommends avoidance of driving after an episode of overt HE, and patients and caregivers should be given verbal and written advice regarding this.[2][61]
Long-term protein restriction is not recommended in patients with HE.
Caregiver discussions
Caregivers should be counseled about early signs and symptoms of HE and what to do if these occur. HE places a considerable burden on caregivers, who report a significant impact on their own health and schedule and a sense of entrapment.[55] Caregivers may benefit from discussions about financial support, respite care availability, and local support groups.
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