Can long term HE cause cognitive issues in my sister at 50?

Question

Hello doctor,

My sister is 50 years old and has cirrhosis due to autoimmune hepatitis. She recently had a severe episode of hepatic encephalopathy (HE), where she remained confused and forgetful for nearly two to three weeks. Her ammonia levels were very high (over 100 µmol/L), and she also had low potassium levels. Even after treatment, she is still having mild memory issues.

Is it normal for hepatic encephalopathy episodes to last this long?
Can prolonged HE cause lasting cognitive problems?
How can we prevent such severe episodes in the future?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Hepatic encephalopathy (HE) can sometimes last for many days to weeks, especially if it is a severe episode. High ammonia levels and electrolyte imbalance, such as low potassium, can prolong recovery.

In some patients, even after treatment, mild confusion or memory problems can persist for some time. This is called incomplete recovery and is not uncommon after a severe episode.

Your sister’s prolonged HE can affect brain function temporarily. It may lead to lasting cognitive slowing or memory issues. However, many patients improve gradually over weeks to months. Low potassium is an important trigger for her episodes because it increases ammonia production in the body. Correcting such factors is very important for recovery.

To prevent future episodes, she can follow the following steps;

Regular use of medications like lactulose and sometimes Rifaximin (non-absorbable antibiotic) is essential. These help reduce ammonia levels.
Diet also plays a role. Protein should not be stopped completely, but taken in a controlled amount with good quality protein.
Avoiding triggers is very important. Common triggers include infection, constipation, dehydration, bleeding, electrolyte imbalance, and certain medicines.
Regular follow-up with a liver specialist and monitoring of ammonia and electrolytes helps in prevention.

Overall, a two to three week episode can happen in severe HE, and mild memory issues can persist, but with proper care and prevention, future episodes can be reduced, and brain function can improve.

I hope this information helps you.

Feel free to ask further queries.

Thank you.