Q. My mom has liver disease with nausea, vomiting and oversleeping. Could it be hepatic encephalopathy?

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 18, 2020 and last reviewed on: Jun 01, 2020

Hello doctor,

This is regarding my mother. She is 55 years old. Last year she was diagnosed with chronic liver disease. She had ascites, which was cured. She has taken proper medication since then. But recently, since the last three weeks to be precised, she was having tremors and difficulty in sleeping. We consulted gastroenterologist here who gave medicines but did not help much with these symptoms. She also has hypothyroid and type 2 diabetes. Since the last two days, she suddenly developed nausea and vomiting and we had to hospitalize her. For now, vomiting and nausea have stopped but she is oversleeping and she still has tremors.

Her sodium, potassium, and creatinine levels are normal. And looking at her liver function test the doctor said she has swelling on her liver and nothing more. But I read somewhere about the symptoms of hepatic encephalopathy like oversleeping, drowsiness, flapping tremors, etc and she has all those at present. Am I right regarding this? Please help me.

Dr. Ajeet Kumar Lohana

Medical Gastroenterology


Welcome to icliniq.com.

I can understand you must be very upset about your mother's health.

The answer to your query is you are 100% right. It can be hepatic encephalopathy (HE). It often presents as altered sleep patterns which means day time sleeping and nighttime awakening. Tremors are characteristically called flapping tremors and sometimes overt neuropsychiatric manifestations such as elevated mood, hallucinations, and illusions.

The treatment of HE is simple i.e. to avoid constipation, and use of lactulose a special laxative agent that help to decrease ammonia gas that causes HE. Plus she should be given tablet Rifxamin 550 mg twice daily to prevent her from recurrent episodes of HE.

The recent use of painkillers could have caused kidney damage which got recovered and may be a precipitating factor for the underlying development of hepatic encephalopathy. I hope this will help you in understanding her problem. I want that you should discuss this information with her treating physician.

Regarding follow up:

Can follow up to discuss more about the long term management of chronic liver disease.

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