At 55, is my brother’s hepatic encephalopathy reversible?

Question

Hello doctor,

My brother is 55 years old and has cirrhosis due to fatty liver disease. Recently, he had an episode where he became very confused and had memory loss for about four days. He could not recognize family members properly and was very drowsy.

His ammonia levels were high (92 µmol/L), and his sodium levels were slightly low. Following lactulose therapy, he gradually improved. Please tell me,

Why does hepatic encephalopathy cause such prolonged memory loss and confusion?
Is this type of episode reversible?
Can it cause permanent brain damage if it happens repeatedly?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Hepatic encephalopathy results from the liver's inability to clear toxins effectively. These toxins, primarily ammonia, accumulate in the blood and reach the brain, impairing its function.

Ammonia interferes with your brother’s normal brain activity and causes swelling of brain cells. This results in your brother's confusion, drowsiness, poor memory, and, at times, an inability to recognize family members.

Low sodium also worsens brain function. It increases brain sensitivity to ammonia, thereby causing symptoms to become more severe and prolonged.

Such episodes can last for a few days, especially when ammonia levels are elevated or when triggers such as infection, constipation, or electrolyte imbalance are present.

The good thing is that most episodes are reversible with proper treatment, such as lactulose, which helps remove ammonia from the body.

However, if these episodes recur or are severe, they can lead to persistent cognitive problems, including poor memory, slow processing, and reduced concentration over time.

So, prevention is very important. Your following routine can reduce his recurrence,’

Regular use of lactulose.
Avoidance of constipation.
Adequate hydration.
Correction of sodium levels helps reduce recurrence.

Overall, this type of episode is typically reversible; however, repeated episodes can gradually affect brain function, so early treatment and prevention are key.

I hope this information helps you.

Feel free to ask further queries.

Thank you.