Is my wife’s memory loss due to encephalopathy?

Question

Hello doctor,

My wife is 38 and diagnosed with advanced liver failure. Since last week, she has had difficulty writing, and her handwriting has become very untidy. She also forgets recent conversations and seems mentally slow.

Are these subtle signs of overt hepatic encephalopathy even without severe confusion?
She drastically reduced her protein intake, fearing worsening. Could very low protein make things worse?
Should Rifaximin be started early to prevent further deterioration?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query.

I understand your concern about your wife, slow thinking, forgetfulness, and her handwriting getting worse can definitely be early signs of hepatic encephalopathy (a reversible, potentially fatal brain dysfunction caused by advanced liver disease or cirrhosis, where the liver fails to filter toxins, primarily ammonia, from the blood) when someone has liver failure. Often, subtle changes like trouble focusing or doing small tasks, such as writing, appear before more severe confusion sets in. Doctors sometimes call these early signs minimal or early overt encephalopathy (a severe, reversible neuropsychiatric complication of acute or chronic liver failure).

It is important to catch these symptoms early, because things can get worse if the triggers are not fixed. Some common triggers are constipation, infections, dehydration, low electrolytes, stomach bleeding, or missing doses of medication.

About diet: it is no longer recommended to cut protein way down. Years ago, patients were told to eat less protein, but now we know that eating too little can cause muscle loss and may even raise ammonia levels. Muscles actually help process ammonia. Most people with liver disease should get enough protein, usually around 1.2 grams per kilogram a day, and plant-based or dairy proteins are often easier to handle.

Medications are key, too. Lactulose is usually the first treatment, because it helps lower ammonia by keeping bowel movements regular. If symptoms keep coming back, doctors might add Rifaximin to cut down on the gut bacteria that make ammonia and help prevent more episodes.

It is a good idea for your wife to see her liver doctor soon. They can check what stage the encephalopathy is at, look for any triggers, and tweak her treatment as needed.

I would advise to give her proper nutrition as it is really helpful in improving symptoms and also prevent the worsening of the condiion.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.